National Plan of Action on Food and Nutrition 1995-2000

• National Plan of Action on Food and Nutrition 1995· 2000 GOVERNMENT OF GHANA National Plan of Action on Food and Nutrition - Government of Ghana CONTENTS List of Acronyms Executive Summary INTRODUCTION 1. Emerging Global Concerns 2. Food and Nutrition In National Development Chapter Two~~~ u. T f". 1 ..~W~ fCYJ;iWiM\~d',1?t~:/W·;l;t~>H1¥'4~\~:'B\~*A:-;~tit0M$if:¥:::;m~~t6'"$ijfk;..-<'4:~:;~><,;m:"&~.b~$~~};Ji;Wt$·i{~;j.Mtt&i}f;:;i,-;&)t,*;W:1' FOOD AND NUTRITION SITUATION 1. Food Availability and Access 2. Protein Energy Malnutrition 3. Micronutrient Malnutrition 4. Diet Related Diseases • 5. Feeding and Caring Practices 6. Causes Of Food and Nutrition Problems Chapter Three . WL if£" Pjj@* S MM W m WliBj,:W""l:WWWN NATIONAL GOALS, OBJECTIVES AND STRATEGIES 1. Statement ofGoals 2. Objectives 3. Strategies 4. Priorities FOOD AND NUTRITION PROGRAMMES Background 1. Adequate FoodlNutrient Intake By Individuals 2. Improved Household Food Security 3. Policy Makers Sensitised On Food and Nutrition Related Issues 4. Strengthening Coordination Among Agencies Involved In Food and Nutrition Issues 5. Improved National Capacity To Deliver Food and Nutrition Education and Services 6. Strengthened Preventive Measures Against Nutrition Related Diseases 7. Increased Adoption of Breastfeeding Practices. 8. Strengthened Participatory Approach To Intervention In FoodlNutrition Projects 9. Increased Adoption ofGood Hygiene Practices By Individuals 10. Increased Adoption of Appropriate Weaning Practices 11. Effective Management of the NPAN Chapter Five .. r..~m'lw IS 11.JIiIU~"¥:;~1'riF$j:\Z~~~$'!*4';f~k»),(~~m~ i~.i~"~.•Ili"rlg~.5M0~,;%,;'~iAt;t""",,k~lW.1bf;""'\'~~~~ FINANCING THE NPAN 1. Introduction 2. Estimated Costs 3. Estimated Financing Requirements COORDINA TING AND MONITORING 1. Introduction 2. Coordinating Mechanisms 3. Monitoring Mechanisms References 2 ~. National Plan of Action on Food and Nutrition - Government of Ghana ACRONYMS ADB Agricultural Development Bank KABP Knowledge, Attitudes Beliefs and AESD Agricultural Engineering Services Practices Division LACOSREP Land Conservation and BFHIA Baby Friendly Health Facilities Initiative Rehabilitation Project (IFAD) Authority MCH Maternal and Child Health BFHI Baby Friendly Health Facilities Initiative MEST Ministry of Environment Science CESD Crop Extension Services Department and Technology CRI Crop Research Institute MLGRD Ministry of Local Government and CRS Catholic Relief Services Rural Development CSPG Cross-Sectoral Planning Groups MM Micronutrient Malnutrition DCD Department of Community Development MOFA Ministry of Food and Agriculture EPC Environmental Protection Agency MOF Ministry of Finance ERP Economic Recovery Programme MOE Ministry of Education FAO Food and Agriculture Organisation MOH Ministry of Health FRl Food Research Institute NBSSI National Board for Small Scale FN Food and Nutrition Industry GAEC Ghana Atomic Energy Commission NCWD National Council On Women and GAPVOD Ghana Association of Private Voluntary Development Organisations in Development NO Nutrition Unit GOP Gross Domestic Product NDPC National Development Planning GDHS Ghana Demographic and Household Commission Survey NDPF National Development Policy GES Ghana Educational Service Framework GFDC Ghana Food Distribution Corporation NGO Non Governmental Organisation GLSS Ghana Living Standards Survey NPA National Plan of Action GNCC Ghana National Commission On Children NPAN National Plan of Action on Food and GOG Government Of Ghana Nutrition GSB Ghana Standards Board NMIMR Noguchi Memorial Institute for HEU Health Education Unit Medical Research HRD Human Resources Department PAMSCAD Program of Action to Mitigate the ICN International Conference On Nutrition Social Cost of Adjustment IDA International Development Association PEM Protein Energy Malnutrition IDD Iodine Deficiency Disorders TUC Trade Union Congress IFAD International Fund For Agricultural UER Upper East Region Development UG University of Ghana IFPRI International Food Policy Research UGMS University of Ghana Medical School Institute UNDP United Nations Development ILO International Labour Organisation Programme ISNAR International Systems for National UNICEF United Nations Children's Fund Agricultural Research VAST Vitamin A Supplementary Trials ISSER Institute Of Statistical Social and WFP World Food Programme Economic Research WHO World Health Organisation ITTU Intermediate Technology Transfer WIAD Women in Agricultural Development Unit III '0' w National Plan of Action on Food and Nutrition - Government of Ghana EXCUTIVE SUMMARY 1. Overall and Specific Goals of the NPAN The overall goal of the NPAN is to contribute to the national goal of sustainably improving the quality of life for all Ghanaians, The specific goal of the NPAN, however is to improve the nutri tional status of all Ghanaians, 2. National Programmes. To contribute towards the overall goal and attain the specific goals, II programmes have been planned for implementation, These are the following: a) Improvements in Household Food Security b) Increasing Food / Nutrient Intakefor Individuals c) Promotion ofIdeal Breastfeeding Practices d) Promotion ofAppropriate Weaning Practices e) Promotion ofGood Hygiene Practices .f) Institution ofPreventive Measures against Nutrition Related Diseases g) Enhanced Participatory Approach to Intervention in Food / Nutrition Projects h) Sensitisation ofPolicy makers in Nutrition Related issues I) Capacity Buildingfor Food and Nutrition Related Education and services j) Improving Coordination ofFood and Nutrition Issues k) Effective Management ofthe NPAN 3. Cost and Financing Requirements The estimated cost of the NPA amounts to US$ 10,4 million. This excludes the cost of complemen tary programmes under Water and Sanitation and Environmental Hygiene. Funding is available for some of the activities envisaged under the NPAN, This is about US$ 2.9 million, The financing gap required therefore amounts to US$ 7,4 million. This works out to be an annual average requirement ofUS$ 1,48 million. 4. Coordination Coordination is envisaged at 3 levels. At the national level, coordination of policies will be the re sponsibility of the NDPC cross-sectoral Planning Groups (CSPG) that have been established under law to serve this function. At the regional level, the Regional Planning Coordinating Units will play the role of the CSPG at the national level. At the district level, the District Planning Coordinating Unit will in consultation with other key institutions be responsible. 5. Monitoring Monitoring indicators have been set for all the objectives (see monitoring under chapter 8). At the national level, the CSPG will collect monitoring information and review them against national tar gets. At the regional level, the Regional Planning Coordinating Units will collect data from the districts as a basis for evaluation. At the district level, the District Planning Coordinating Unit will do the moni toring based on the monitoring data and district targets. iv " , National Plan of Action on Food and Nutrition - Government of Ghana CHAPTER 1 INTRODUCTION • 1.1 Emerging Global Concerns The past decade saw global efforts at assessing the magnitude of nutrition problems against a back ground of a World that had the resources and technology to ensure adequate nutrition for all. Pro tein-Energy Malnutrition (PEM), nutritional anaemia, vitamin A deficiency, iodine deficiency, diet related diseases, infections and parasitic diseases are serious global problems. The overaIl availability of food in the world is not a problem (UNDP, 1994). There is also enough food to offer every one in the world around 2,500 calories a day, that is 200 calories more than the basic minimum. In developing countries, per capita food production increased by 18% on the average in the 1980s. Inspite of this some 800 million people are estimated to go hungry daily. In Sub-Saharan Africa despite the appreciable increase in food production, about 30% of the popula tion are malnourished. In South East Asia, 30% of the babies are born underweight. These are indi cations of inadequate access to food. PEM afflicts 150 million children under 5 years worldwide. It is estimated that 350 million women have nutritional anaemia. Some 40 million children suffer from vitamin A deficiency, 250,000 of whom go blind while iodine deficiency disorders (IDD) afflict about 200 to 300 million people with goitre and at least 6 million people suffer from cretinism. Iron deficiency anaemia is prevalent in about 1.5 biIlion people and produces anaemia in about 1.2 billion of them. It is esti mated that nearly 90% of all anaemia in the world are due to iron deficiency. Major causes of death in developing countries are infectious and parasitic diseases (UNDP, 1994). These kill about 17 million people annually including 6.5 million from acute respiratory in fections, 4.5 million from diarrhoeal diseases and 3.5 million from tuberculosis. Most of theses deaths are due to poor nutrition and unsafe environment, particularly polluted water which contrib utes to nearly one billion cases of diarrhoea a year. In both the developing and the developed coun tries, and more especially the latter, the major killers are diseases related to the circulatory system which is linked to diet and life style. Recent reports indicating that malnutrition is on the ascendancy in some parts of the world, es pecially Sub-Saharan Africa have increased the global awareness of the problem. Consequently ob jectives and strategies embracing the problems of malnutrition have featured prominently in a number of international fora. Prominent amongst these are: the World Food Conference, 1974; the Alma Ata Conference On Primary Health Care, 1978; the World Conference On Agrarian Reform and Rural Development,1979; the Convention On the Elimination Of All Forms Of Discrimination Against Women, 1979; the Innocenti Declaration On the Protection, Promotion and Support Of Breastfeeding, 1990; the Montreal Policy Conference On Micronutrient Malnutrition, 1991 and the Rio Declaration On Environment and Development, 1992. Nutritional goals have also been set by the Fourth United Nations Development Decade and the 1990 World Summit On Children. The International Conference on Nutrition held in Rome in 1992 also strengthened world wide commitment to take action to prevent and alleviate malnutrition. This meeting re-affirmed the World's commitment to attack all forms of malnutrition by addressing the underlying causes of inadequacies in food, health and care, as well as the root causes of underdevel opment and poverty. The Conference also reiterated its commitment to the World Summit On Chil dren's nutritional targets and added new goals to eliminate famine and starvation. All these declarations and commitments were made in recognition of the fact that access to nu tritionally adequate and safe food is a right of each individual. Ghana is committed to the attainment of the goals entailed in these international declarations and has for some time recognized the right to access by the individual to nutritionally adequate and safe food for all her citizens through national development programmes. , ' • National Plan of Action on Food and Nutrition - Government of Ghana 1.2 Food and Nutrition in National Development Ghana realizes that hunger and undernutrition are caused by several factors which require coor dinated effort to address, Accordingly, in a recent government development policy document titled Ghana - Vision 2020 (The First Steps), improvements in the nutritional status of Ghanaians occupy a prominent place. Current and past development efforts have incorporated policies that specifically address the nutrition problems of the people. The main thrust of these policies is to make food avail able at reasonable prices to consumers, make the population adopt better nutrition practices and re duce malnutrition. Agricultural policies to promote better nutrition are being pursued. These cover increased food production in the context of sustainable environment, price incentives, enhanced ac cess to inputs, improved storage systems and minimisation of the constraints to the marketing and distribution of food. Policies to increase the production of meats include adoption of appropriate breeding systems, enhanced availability of inputs and extension services and improved hygienic practices in the marketing of meats. A rural feeder roads expansion policy being promoted is to re duce food transportation costs and ultimately promote affordable prices. Health policies to enhance nutritional status include public education on the need, availability and use of foods, especially to mothers and children. Supply of micronutrient supplements to the most at risk is being undertaken. The curricula of pre-service health facilities are up-dated on a con tinuous basis to cover developments in the promotion of better nutrition. Health extension workers routinely include nutrition education in their programmes. Basic school education programme cov ers the establishment of school based canteens, supervision of school based food vendors and the promotion of nutrition education. 2 National Plan of Action on Food and Nutrition - Government of Ghana Chapter 2 FOOD AND NUTRITION SITUATION 2.1 Food Availability and Access 2.1.1. Food Availability Though there has been a general increase in food supply since the inception of the ERP, by 1990 Ghana was only 70 % self sufficient in cereals production, 60% in fish, 25% in meat and less than 20% in raw materials for agro-based industries (MOA, 1990). The domestic production capacity of rice, a major cereal item however is 50% of the national requirement. Root and tuber crops, the most widely used staple food crops contributed to about 43% of agricultural GDP in 1993. Food imports and aid supplemented the domestic shortfall with the former averaging about 5% of the total imports. Meat and fish production fall short of estimated national demand. The combined meat produc tion is only about 23% of the estimated annual demand of 195,000 metric tonnes (FAO, 1993). Fish provides 36% of the protein requirement of Ghanaians. Annual production estimated at 274, 000 metric tonnes for the last few years is about 60% of the potential domestic demand. Fish production is hampered by the potential over exploitation within the *200/300 nautical miles Exclusive Eco nomic Zone and a fall in incomes as a result of glut in supply during the main harvesting season in June to September (when about 40-50% of the annual catch takes place). In the case of poultry pro duction, the high import cost of feed and layers and the unrestricted importation of poultry products are the two main constraints restricting the sector's growth. While efforts at increasing food availability over the past decade appear to have borne some fruits, considerable obstacles remain in Ghana's efforts to achieve national food self sufficiency. The obstacles span ecological and physical constraints, poor soils, negative effects of land rotation, in adequate inputs, increased pressure on available land and inadequate levels of institutional support. Ecological and physical constraints are manifested by erratic, uneven and short duration of the rain fall pattern. Sometimes fluctuations of heavy rains within and between agricultural seasons destroy both crops and livestock. Rainfall whose control is beyond the capability of the small farmer is thus a major determinant not only of the cropping pattern but also of the annual fluctuations of total household and national food output. Most lands are covered by poor fertility soils with poor physical properties, dictated by low or ganic matter content (MOFA, 1989). The organic matter on the top soils are rapidly depleted through heavy rains, excessive leaching due to the acid nature of the soil and more intensive cultivation as a result of the pressure on the land. The problems associated with poor ferti lity soi Is are compounded by land rotation system of the small farmer who contributes about 90% of the food production. The resulting pressures on the land has shortened the bush-fallow cycle, thus increasing the soil degrada tion and environmental problems which are inimical to food and livestock production. The seed propagation industry is yet to produce improved seed varieties that are timely deliv ered, within the reach of the farmer and in adequate quantities. Though efforts have been made at maintaining an adequate stock of fertilizers together with farmer education on fertilizer use, there appears to be a decline in their use(a situation blamed on high prices of the commodity) at a time of extreme population pressures on land and shortening of the fallow period. While farm mechanization restricted by ecology to parts of the mid, northern and south east could boost food production, the high cost of oxen for animal traction, fuel for tractor use and relatively high cost of imported equip ment, make this impossible. Institutional support to agriculture covering food, livestock and fisheries production span re search, extension service, credit, mechanization and marketing. Though about 300 research scientists (lSNAR, 1991) are engaged in activities related to agriculture, only 20% of the research time is de voted to food crops. That aside most food crop research efforts have produced results in mostly new varieties of maize and cow peas. Very little has been attained in improved technologies in yam, co 3 • National Plan of Action on Food and Nutrition - Government of Ghana coyam and plantain the main staple foods. Research efforts on livestock and fishery production are inadequate viewed against their potential to increase the protein status of most Ghanaians. The extension officer to farmer ratio of 1:1800, with a special focus on food production, proc essing, nutrition, child care and home management could have been more effective if poor mobility and motivational problems facing the extension officer coupled with the low literacy base of the farmers are solved or improved. Though credit sources are available to the farmer, high interest rate and unfavourable repayment terms have created a situation where only a small fraction of the total small holder farmers had access to loans during the late 1970s and the early 80s (MOFA, 1990). 2.1.2. Access To Food Access to food has two components, the financial and the physical. Financial access determines the ability of the household to produce or buy sufficient safe and good quality food to meet the die tary needs of all its members (FAO, 1993b). Physical access refers to the movement from food sur plus areas to deficit areas. This encompasses road network, storage facilities and the distribution system. Financial access is determined by a combination of income levels, its distribution and the pur chasing power of the incomes earned. This combined effect contributed to a situation whereby in 1987/88 64% of all household expenditures were allocated to food and more than 33% of household surveyed did not purchase or retain from home production enough to meet 85% energy needs based on moderate activity levels (GLSS, 1988). Adequate access to other foods especially fish and meats are restricted to relatively high income groups and households. However in the rural areas where most people are generally poor, households that rear livestock and poultry may have access to meat and poultry. Income differentials by relpions appear to be a cause for the uneven spatial access to food. In a survey conducted by Alderman strong indications of regional patterns of poverty tended to correlate positively with regional access to food. For instance in the Upper Regions where the highest malnu trition are recorded, low incomes appeared to be the main constraint to increased calorie consump tion. Since sorghum and millet form the basic diet of the inhabitants in the Upper Regions any food policy that strengthens the productive capacity of these staples will in the long run improve the nutri tional status of the people in these regions. On the physical side, inadequate and at times impassable road links between the urban and the rural areas creates situations of rural gluts and urban scarcities in food, which lead to increased food prices in the urban areas that do not reflect the true supply situation in the country. Also despite the improved physical distribution network of agricultural products, construction of silos in selected food growing areas, especially maize growing areas, about 20-30% of production is lost due to the poor traditional post harvest management of food crops (MOFA, 1991). Losses of this magnitude have a positive effect on prices which in tum restrict access to food at the household level. 2.2. Protein Energy Malnutrition (PEM) PEM is the most widespread and serious nutritional disorder amongst children in Ghana. Many children suffer from moderate to severe forms of PEM. The DHS of 1988 indicate that stunting be gins very early in life and 30% of children 3-36 months of age are affected, while 31% of the same age group are underweight. Severe malnutrition, wasting was found in 8% of the children. The GDHS of 1993 reveals that for children under thirty six months old 26% are stunted, 28% are un derweight and 12% are wasted. These conditions were found to be more severe in the Northern, Up per West, Upper East and Western regions. For children of school going age (10-14 years) available evidence shows that there is 10.5 % wasting and 49.6% stunting in the rural areas with the corresponding figures for the urban areas being I Alderman Il., ( 1990) Nutritional Status In Ghana and Its' Determinants, SDA Working Paper No.3 Washington DC. The World Bank 4 National Plan of Action on Food and Nutrition - Government of Ghana 4.3% and 21.3% respectively. The geographical distribution of PEM in terms of its severity and magnitude indicate that nutritional status of children living in the coastal areas is better compared to those in the forest and northern sector zones. In the northern zones more boys (63%) showed acute malnutrition (weight for height) than girls (49.6%). Chronic dietary energy deficiency characterizes the northern savanna zone. It is estimated that 65% of pregnant women and 45% of non-pregnant women examined in Northern Ghana showed symptoms of PEM (World Bank 1989). In contrast, 43% of pregnant women and 30% of non-pregnant women suffered from PEM in the south. Though adults form the best nourished group of the population, there appears to be a decline in nutritional status of adults over 50 years of age. This is manifested in lower weights and increased signs of malnutrition. There are differences in adult nutrition status by occupational grouping. Farmers, both men and women are the worse off while wage earners and self employed women had the best nutritional status. This implies that those on or near a moneyed economy have a better nutritional status than those near a subsistence economy. 2.3 Micronutrient Malnutrition (MM) The main micro-nutrients of public health importance are- Iodine, Vitamin A and iron. Defi ciency of these micronutrients leads to low productivity and may affect the physical and mental de velopment of the individual. In recent years work has been done to establish their prevalence in the country. 2.3. I. IDD Documentation on IDD span over 30 years. In 1960, WHO reported high prevalence of goitre in several areas in the Upper region. Until 1991, there had not been any attempt to determine the magnitude of the IDD problem. In January 1991 a pilot IDD survey in Builsa and Sekoti (a cluster of seven communities) indicated that 70 to 80% of the school aged children and women of child-bearing age had goitre with about 8 - 20% visible goitre. Urinary iodine analysis also indicated that about 72% of the study population had levels below the accepted levels. The 1992-1993 national IDD sur vey indicated that 33% of the 27 districts surveyed had moderate to severe IDD problem. The prob lem also exists in the remaining 67% but at a lower level. 2.3.2. Iron Deficiency The existence of iron deficiency anaemia as a public health problem was first revealed by the 1961 National Nutritional Survey. The survey found that anaemia was widespread among pre-school children, pregnant and lactating women. The situation has not changed since then. For instance 23% of all children admitted to a hospital in Ghana in 1991 received blood transfusion for severe anaemia. Ninety-five percent of these were school children. Sixty-nine percent of pregnant women who at tended ante-natal clinic in 1987 were anaemic. In 1990, a study of apparently healthy female students found 17.4% of them anaemic by WHO standards for non-pregnant women. 2.3.3. Vitamin A Deficiency It has long been noted that Vitamin A deficiency is endemic in Northern Ghana. Vitamin A supplementation trials (VAST) studies conducted in the Upper East region showed that while xerophthalmia prevalence was 1.6 percent on the average, nearly 65 percent of the children examined had low serum retinol levels. In 1994, a study in Kintampo District also found that 51 percent of the children sampled had low serum retinol levels. In another study carried out in 1988 in a rural coastal population, low serum retinol levels were found in 85 percent of pre-school children and 59 percent ofprimary school children. The VAST studies also demonstrated that it is possible to obtain a 19 percent reduction in mor tality in children aged 6 months to 5 years by the use of periodic supplementation with large doses of vitamin A. In addition, supplementation had a significant effect in reducing the severity of illness in children. 5 National Plan of Action on Food and Nutrition - Government of Ghana 2.4. Diet Related Diseases The Situation Analysis on Children and Women undertaken by GOG and UNICEF in 1990 indi cated that 32% of maternal deaths in Ghana is due to Cardiovascular disease. Lifestyle such as ex cessive alcohol consumption, drug abuse, lack of regular physical activity or exercise and eating of unhealthy diets (eg high fat) contribute to ill health and thus affect nutritional status. 2.5. Feeding and caring practices Feeding patterns, in addition to diarrhoeal diseases, are important determinants of undernutri tion. The WHO recommends that all infants be exclusively breastfed from birth to 4 to 6 months of age. Though breastfeeding initiation is widely practiced in the country with prevalence rate of more than 90% at birth and average duration of 20.4 months, the GDHS (1993) reveals that only 8 in 100 children under the age of four months are exclusively breastfed as recommended by WHO; 4 in 10 of infants under 4 months old are given some form of supplemental feeding, which is not recom mended; and to a large extent the failure to exclusively breastfeed for the first four to six months of life accounts for the rapid increase in undernutrition among young infants. Educational levels tend to influence the magnitude and the incidence of breastfeeding. Intro duction of liquids and solid foods take place far too early in life. This practice tends to undermine better nutrition. Secondly, the liquids and solid foods are inferior nutritionally to breastmilk. The intake of these reduces the amount of breastmilk intake which in tum reduces the mothers supply of milk since breastmilk production is determined in part by both the frequency and the intensity of the suckling. Thirdly, feeding young infants liquids and solid foods increases their exposure to patho gens and consequently puts them at risk of additional diarrhoeal diseases. Many of the common breastfeeding practices found are not conducive to optimal lactation. In fants are rarely put to breast in the first half hour after birth and mothers in hospitals may have to wait for 24 hours or more before being given the opportunity to nurse their babies. Both mother and health professionals often believe that nursing should be delayed until the milk starts to flow. Colos trum is often discarded by mothers believing that it is not good for the baby. In a survey only 50% of mothers fed their babies with colostrum (MOHI Nutrition Division, 1989). Prelacteral feeds includ ing water, glucose water and infant formula are commonly given both in and outside hospital. Rea sons mothers give for the early supplementation include perceived insufficient milk, infant crying, breastfeeding problems, advice from health professionals and the need to return to work. Health pro fessionals often support this practice of early supplementation, claiming that women are too poorly nourished or too busy to breastfeed exclusively. Practices such as children eating together from the same bowl deprive some children from eating adequately because they cannot compete. They end up being chronically malnourished or stunted. The concept of what constitutes a meal also prevents individuals from having balanced diets. The carbohydrate part of the meal is considered the most important part since it constitutes the bulk of any meal. Growing urbanization has created slums in the cities and this state of affairs keep worsening with the years and with health and nutritional status of these migrants. Available evidence shows that urban mothers who are relatively well educated breastfeed for about 17 months. Their rural counterparts who are less educated breastfeed for about 20.4 months. Mothers in the Greater Accra and Central Regions breastfeed for the shortest periods while those in the Northern and Upper Regions breastfeed most. Once again the underlying factor is urbanization and education. The former regions are more urbanized with the mothers well educated than the latter regions, The social role and position of women also have influence on feeding and caring for infants and children. Traditionally, women work inside and outside the home, mothering and nursing children, cooking, processing and storing food. They also participate in agricultural work,farming different crops and market produce either on their own or jointly with their husbands or kin. They also playa role in fetching water and fuelwood, washing, taking care of children, the sick and the aged and pro 6 National Plan of Action on Food and Nutrition - Government of Ghana moting the health and well being of other family members of the family. These activities reduce the ability of women to devote enough time to their infants and children (Children and Women of Ghana: A Situation Analysis. Republic ofGhana/UNICEF. Accra, June 1990). 2.6. Causes of food and nutrition related problems The current food and nutrition related problems in Ghana have been analysed and classified into the following broad areas: immediate, underlying and basic causes. Figure I. Causes of Malnutrition Immediate Underlying Basic I Malnutrition I / I IHigh Incidence Inadequate Food I of Diseases I Intake / <, I I I Ineffective Poor Environmental Poor Dietary Poor Agricultural Inadequate Supply Health Sanitation Practices and Practices of Food at Delivery Beliefs Household Level System I \ / Integrated National Policy Makers Policy on Food and insensitive to Nutrition non-existant Nutrition issues 7 National Plan of Action on Food and Nutrition - Government of Ghana Figure 2 Underlying causes of malnutrition a) Causes due to high incidence of diseases Poor envieronmental sanitation Poor Hygiene Practices Limited institutional capacity to deliver ...---------teducation and services in food and nutriton t-------.., Poor coordination among NOOs/ Implementing agencies 8 Policy makers insensitive to Integrated national policy 1on food and nutition is non National Plan of Action on Food and Nutrition - Government of Ghana Poor weaning Practices High influx of artificial foods Education on food consumption measures is incom lete Inadequate Food / Nutrient intake High resistance to change in food and nutrition ractices Poor intra household food distribution Conflicting nutrion messages to beneficiary rou s Poor knoledge on nutient value offood at household b) Causes due to Dietary PracticeslBeljefs Time spent on childcare limited Non involvement of beneficiaries in assessment Time and energy spent on house chores too high Donors intervene with re-conceived ideas c) Causes due to Agricultural practices Inadequate food /nutrient intake 1-----------------1 l--~-- ,r --' Inefficient food marketing High incidence of post harvest losses 1------1 '------,-"----' Low agricultural production Low farm gate price Low utilisation of improved food production technology Lack of access to credit by women small farmers, small scale processors and traders Rapid deterioratimg physical environment for food production Ineffective agricultural extension system Low food marketing infrastructure in rural areas Institutional capacity to improve and maintain food and marketing structure is weak 9 National Plan of Action on Food and Nutrition - Government of Ghana Figure 3 Basic Causes of Malnutrition Limited Budget to rural areas Donors intervene with pre-conceived ideas about food and nutrition Poor coordination amongNGOs implementing agencies Intergrated national policy on food and nutrition is non- existent Poor logistic support for delivery of services Policy makers are insensitive to nutritional issues Inadequate food I nutrient intake 1-------------------..,::001 ..>---r--~-----l Poor linkage between researchers and agricultural extension 10 , National Plan of Action on Food and Nutrition - Government of Ghana Chapter 3 National Goals, Objectives and Strategies 3.1 Statement Of Goals The overall goal of the NPA/FN is to contribute to the national goal of sustainably improving the quality of life for all Ghanaians. The goal of the NPA/FN is to improve the nutritional status of all Ghanaians 3.2 Objectives It is anticipated that the following objectives would be achieved by the year 2000 . I. Adequate food/nutrient intake by individuals 2. Improved household food security 3. Policy makers sensitized in food and nutrition related issues 4. Strengthening coordination among agencies involve in food and nutrition issues 5. Improved national capacity to deliver food and nutrition education and services 6. Strengthened preventive measures against nutrition related diseases 7. Increased adoption of breastfeeding practices 8. Strengthened participatory approach to intervention in food and nutrition projects 9. Increased adoption rate of good hygiene practices by individuals 10. Increased adoption ofbreflstfc:eding plactices ct'I"'J('i.- ( 11.-';(( II A. fj)CC7/LH r" I i ri I~' i c. I ) tl I"'; IU vi (, ". , . i /,0 " ,-ie. i 3.3 Selecting the Priorities Priority areas for action within the programme areas have been selected on the basis of the following criteria: Enhanced earnings capacity of the individual: The situation analysis indicates that poverty is a major cause of the present nutritional status. Consequently efforts that will in crease rural incomes, mainly increased production enabling small holder farmers to have surplus for sale to supplement their other dietary needs. Immediate positive impact: Micronutrient malnutrition appears to afflict a sizeable number of the people. Iodine and vitamin A supplements distributed to targeted groups as ef forts are being made to raise their income and nutrition based knowledge levels will impact positively within the possible shortest time on the nutritional status of the people. Building on existing and planned initiatives: Existing and planned initiatives in the provi sion of social and physical infrastructure will be built on. Programmes in agricul ture, health, education and rural infrastructural support that have bearing on nutrition will be pursued in context ofthe goals ofthe NPA Promotion of desirable ends: Every society aspires to having a healthy population. Pro grammes to be supported will not only focus on nutrition but health in general. Breastfeeding, clean and safe water contributes to the good health of the child. Promoting better lifestyles and appropriate dietary habits and focusing on infectious diseases improve both the health and nutrition status of the people. The attainment of these desirable ends could be enhanced (not subject of NPA) if environmental sanitation and water supply are improved and sustained. II National Plan of Action on Food and Nutrition - Government of Ghana Chapter 4 Food and nutrition programmes Background Ghana's food and nutrition programmes within the context of the NPA are based on the achievement indicators set in 8.4. Within the overalI national programme, there are eleven sub programmes defined to be consistent with each other. The sub-programmes are clearly delineated in terms of activities, duration, coordination and estimated cost. The major assumptions under which the expected outputs of the NPA would make an impact on the nutritional status of Ghanaians are: Rate of increase in food production will at least match the rate of increase in the population. Financial resources will be available to carry out the activities. Farmers incomes will improve in real terms. Physical and financial access to improved health care will be enhanced. Access to formal and non-formal education wilI be expanded. Capacity and commitment of institutions involved in the implementation of the PAIFN will be integrated and sustained. The implications of these assumptions are expected to positively reinforce the planned activities envisaged under the NPA. For example existing programmes in agriculture and population are ex pected to ensure a balance between population growth and food availability. If this is not achieved, the attainment of some ofthe goals envisaged by the NPA will not be met. Improved real incomes of farmers currently being pursued under poverty alIeviation programmes are expected to enhance fi nancial access to balanced diets. Expanded level of literacy currently going on under NFE and Basic Education programmes wilI form the basis for carrying out food and nutrition education under the NPA. 4.1 Adequate Food/Nutrient Intake By Individuals a) Present situation PEM afflicts a sizeable number of children under 5 years and some pregnant women. IDD is highly prevalent in the Northern, Upper West and Upper East regions and in the mountainous areas in the southern part of the country. Low serum retinol levels have been reported in the Upper East Region and some dis tricts in the forest and coastal zones. IDA is a problem affecting alI sex and age groups but especialIy among pre-school children, pregnant and lactating women. Diet related diseases such as hypertension, cardiovascular and diabetes between the ages of 40 and 55 have been observed to be increasing. Practices such as children eating together prevents some children from eating adequately because they cannot compete with each other. Intra-household food distribution favours adults. b) Past and present initiatives Vitamin A capsules have been distributed in the Upper East Region. Vitamin A Supplementation Trials have taken place in the UER. Framework for national vitamin A deficiency control programme has been drafted. Nutrition education is being carried out on a continuous basis by extension workers and also in health institutions. A survey on iron deficiency anaemia is in progress Iron folate supplements are given to women regularly at ante natal clinics 12 National Plan of Action on Food and Nutrition - Government of Ghana Standards for iodated salt have been initiated. Processes for salt iodation have been developed. Iodised oil capsules are being distributed in highly endemic areas. A laboratory for monitoring micro-nutrient status has been put in place. Supplementary feeding programmes with emphasis on malnourished children, nursing mothers and expectant women are being organised in 5 regions. Nutrition rehabilitation services for severely malnourished children are being provided through 23 non-residential and 13 residential centres country wide. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY 1.1 Carry out extensive food January-December 1996 NU/MOFA/Universities consumption survey 1.2 Design/launch a short-term programme which will provide Start June 1996 MCH- MOH/UGMS/NU essential supplements 1.3 Develop nutrition education materials to improve knowledge on nutrient value of foods and nutrient needs for venous On-Going HEU/MOE/NU physiological states 1.4 Develop criteria for identify ing target groups for supplementary feeding pro- September-December 1995 NU/DCD gramme 1.5 Put in place measure to involve communities in planning As soon as NP/FN is CSPG (NDPC I nutrition programmes launched 1.6 Design and implement a more effective and sustainable supplementary feeding June 1996-December 2000 NU/GAPVOD/MCH programme 1.7 Identify and fortify common FRI/NMIMR/U niversities/ foods to ensure adequate January 1996 GSB supply of micronutrient 1.8 Undertake educational programmes to promote dietary On-Going HEU/NU/WIAD/DCD/NGOs diversification 13 · . National Plan of Action on Food and Nutrition - Government of Ghana 4.2 Improved Household Food Security a) Present situation In 1990 Ghana was only 70% self sufficient in cereal production, 60% in fish and 25% in meat production (MOA, 1990). 33% of households did not retain from home production or purchase enough food to meet 85% of energy needs based on moderate activity levels (GLSS, 1988). Access to food is constrained by regional income differentials against the Northern and Upper Regions against a background of inadequate food supplies and consequent cyclical upward trend in food prices (Alderman, 1991). Poor storage facilities at the farmlhousehold level contribute to food inadequacies during the post-harvest periods. b) Past and present initiatives Extension work in crops, livestock and fisheries based on the outcome of local research institutions is assisting farmers to increase production. WIAD of MOFA is assisting poor farmers and women in food storage, processing and preservation for food security and better nutrition. MOFA, ADB and GFDC are assisting farmers in selected food growing areas with credit, storage and market identification services. Rural agricultural infrastructure including small dams and roads are being expanded. Appropriate technologies are being adopted for agro-processing, soil and water management, conservation, animal traction and basic agricultural machinery. NGOs are assisting small farm families/small scale operators in food production, food storage, processing and marketing; micro enterprise development, and local weaning food production. 14 National Plan of Action on Food and Nutrition - Government of Ghana c) Sub-programme activities ACTIVITY RESPONSIBILITY TIMING 2.1 Identify causes leading to Started to be completed by MOFA ( PPMEDj/ISSERj household food insecurity December 1998 IFPRI/UNICEF 2.2 Design an effective pro gramme to alleviate Started in Northern and bottlenecks in the marketing Transition zones. MOFA of farm agricultural inputs and Start January 1996 in products Southern Zone 2.3 Define and clarify work schedule of extension staff On-going MOFNNGOs/NU/DCD 2.4 Train more extension staff including specialists to promote the use of improved On-going MOFNDCD/NGOs technology 2.5 Engage and train more December 1995- January women for extension work 1996 MOFNND/MLG/NGOs 2.6 Set-up effective credit facility for farm families On-going MOF/NGOs/MOFA 2.7 Develop guidelines on the use of available but unexploited June 1996-December 2000 MOFNCRI/DFS-UG/DHS foods UG 2.8 Create an enabling environment for small March 1995-December MESP/NBSSI/NGOs enterprise development 2000 and off-farm employment 15 National Plan of Action on Food and Nutrition - Government of Ghana 4.3 Policy Makers Sensitised On Food And Nutrition Related Issues a) Present situation Low awareness of policy makers of the magnitude of food and nutrition problems. No framework for the sensitisation of policy makers on food and nutrition issues. b) Past and present initiative CSPG on food and nutrition put in place by the NDPe. Seminar on food security, nutrition and development has taken place for policy makers. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY 3.1 Set up directory on key pol icy makers on food and May-July 1995 NDPC/NU nutrition 3.2 Develop a continuous pro gramme for dissemination of Start July 1995 NDPC information to key policy makers 3.3 Conduct a survey on the Knowledge, Attitudes, Beliefs January-March 1996 NDPC/ISSER and Practices of Policy makers 3.4 Develop mechanisms to involve policy makers in the formulation of food and March-June 1996 NDPC/MOH-PPMED/NU nutrition activities 3.5 Set up network of food and nutrition practitioners to March-June 1995 NPNICN Task Force advocate the involvement of policy makers 3.6 Communicate national plar September 1995-March MLG/ICN Task Force of action for food and nutrition 1996 to district implementers 16 National Plan of Action on Food and Nutrition - Government of Ghana 4.4 Strengthening Coordination Among Agencies Involved In Food And Nutrition Issues a) Present situation Ineffective information sharing mechanisms between agencies. Mechanisms for inter-agency coordination have not been fully recognized and utilised. b) Past and present initiatives Cross-Sectoral Planning Group on food and nutrition is in place. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY 4.1 Set up directory on agencies in nutrition-related June 1995, Week 3 CSPG activities 4.2 Reactivate CSPG organised June 1995, Week 1 CSPG by the NDPC 4.3 Develop quarterly Newslet ter to inform all sectors /agencies involved in nutrition January-March 1996 CSPG related activities 4.4 Organise annual symposia on National/Sub-National Food and Nutrition Policy and pro- October each year CSPG grammes 4.5 Conduct joint orientation for July 1995, Week 2 CSPG collaborating agencies 17 National Plan of Action on Food and Nutrition - Government of Ghana 4.5 Improved National Capacity To Deliver Food And Nutrition Education And Services a) Present situation Coordinated planning for manpower in support of food and nutrition programmes does not exist. Institutional linkages in support of food and nutrition programmes are weak. b) Past and present initiatives "Nutrition Facts for Ghana" has been developed for use by all agencies to ensure standard nutrition education. Nutrition is integrated in curricula of teachers and extension workers. c) Sub-programme activities ACTIVITIES TIMING RESPONSIBILITY 5.1 Develop manpower plan to support food and nutrition September 1995-2000 MSD-OHCS/ICN Task Force programmes 5.2 Mobilise Government and donor support for capacity Start June 1995 UNICEF?MOF/MOH/MOFA building 5.3 Establish linkages with National Agricultural Research Start July 1995 ICN Task Force Project 5.4 Train teachers and other change agents in food and On-going MOE/MOH/MOFA nutrition 18 • National Plan of Action on Food and Nutrition - Government of Ghana 4.6 Strengthened Preventive Measures Against Nutrition Related Diseases a) Present situation Lack of data on extent of some diet related diseases. b) Past and present situation Nutrition curricula at various levels of education are being reviewed and expanded. Awareness creation programmes of some diet related diseases have been mounted. Studies on some nutritional problems are being conducted. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY 6.1 Initiate and sustain aware ness creation programmes on On-going NU/WIAO/NGOs/MOE good nutrition and nutrition related diseases 6.2 Prepare national guidelines on dietary requirements April 1996-March 1998 NU/FRIjUG-OFS 6.3 Expand nutrition curricula at various levels of formal education and training institu- On-going MOE/MOFNMOH tions 6.4 Clarify the role of agencies June-September 1995 MOH/GSB/MLG/MOFA in enforcing food laws VO/EPA 6.5 Build capacity of related October 1995-0ecember MOH/GSB/MLG/MOFA agencies in enforcing laws 2000 VO/EPA 6.6 Conduct continuous studies On-going MOH/NMIMR/UG on nutrition related diseases 19 • National Plan of Action on Food and Nutrition - Government of Ghana 4.7 Increased Adoption Of Breastfeeding Practices a) Present situation Exclusive breastfeeding is practiced among 8% of mothers of infants under 4-6 months of age. Duration of breastfeeding for children under 3 years of age is 21 months. 40% of children under 4 months are breastfed at the same time given some form of supple mentation. Prevalence rate for breastfeeding initiation is more than 90% at birth. 16% of infants are put to the breast in the first hour after birth. Colostrum is often discarded by some mothers. Prelacteral feeds are commonly given both in and outside hospital. Use of feeding bottles for infants under 4 months is high. 36% of infants aged 6-9 months are fed solid food in addition to breast milk. b) Past and present initiatives Law guaranteeing 6 weeks pre and 6 weeks post partum fully paid maternity leave plus two additional weeks in the case of complications or multiple births has been enacted in accordance with ILO convention. Ghana Code on breast milk substitutes has been drafted. Baby Friendly Hospital InitiativeAuthority has been formed. 5 Ghanaians have received overseas training in lactation management. Training of health professionals on lactation management have been initiated. Education on ideal breastfeeding practices is given in all health institutions. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY 7.1 Design an effective in-service training programme for existing On-going MCH/Nutrition Unit health and allied staff BFHIA/GAPVOD 7.2 Designate all health facilities and maternity homes baby friendly On-going BFHIA 7.3 Form mother support groups BFHIA/WIAD/DCD in communities On-going MCH/NUand GAPVOD 7.4 Provide facilities to enable Employers association working mothers breastfeed Start June 1995 TUC Women's desk Civil servant association 7.5 Advocate for the enactment of the code on marketing of On-going HEU/MOH; MCH/N£HI breastfeeding substitutes BFHIA 7.6 Develop IEC materials On-going HEU/MOH; MCH/NU/BFHIA 7.7 Conduct research into breast- January 1996-December NMIMR/HRU-MOH/DNFS feeding practices 1997 UG 20 National Plan of Action on Food and Nutrition - Government of Ghana 4.8 Strengthened Participatory Approach To Intervention In FoodlNutrition Projects a) Present situation Grassroots level participation in the design of food and nutrition projects is non existent. The conceptual framework for grass root participation requires clarification and strengthening. b) Past and present initiatives District planning systems have been put in place by government. Food and nutrition extension programmes exists in many districts. Training of trainers in participatory methods have been initiated. c) Sub-program activities ACTIVITY TIMING RESPONSIBILITY 8.1 Conduct action research and disseminate information on participation at the community June 1995-June 1996 NDPC level 8.2 Conduct action research into methods of securing participation June 1995-June 1996 NDPC 8.3 Advocate food/nutrition teams September 1995-March at village and district levels 1996 ND/WIAD/NGOs/DCD 8.4 Initiate community programme DHMT; District teams planning fora on food and nutrition Start April 1996 for food and nutrition 8.5 Develop guidelines to avoid Already started. Ends April NU conflicting nutrition messages 1995 8.6 Train Trainers in participatory methods On-going NGOs/NDPC/WIAD/NU 8.7 Advocate for food and nutrition NDPC/MOH/ND/MOFA issues to be addressed by district Start June 1995 WIAD; MLGRD and community-based organisation 21 • National Plan of Action on Food and Nutrition - Government of Ghana 4.9 Increased Adoption Of Good Hygiene Practices By Individuals a) Present situation Public awareness level of good hygiene practices is low. Vendors of street foods do not adhere to good hygiene practices. b) Past and present situation lEe materials are being developed and disseminated on good hygiene practices. Targeted messages have been developed. On-going public education on good hygiene practices. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY 9.1 Design a more effective hygienic/health education July 1995-July 1996 HEU/NU/MLGRD programme 9.2 Develop a combination of educational materials and On-going HEU/GES methods to directly influence behaviours 9.3 Prepare messages targeted at women's groups, school pupils,for use on radio, On-going HEU/GES TV, and community centres 9.4 Organise special quiz programmes for school pupils Start October 1995 HEU/GES 22 National Plan of Action on Food and Nutrition - Government of Ghana 4.10Increased adoption of appropriate weaning practices a) Present situation Knowledge on appropriate weaning practices is inadequate. Access to food by some mothers for the preparation of weaning foods is constrained by their low levels of incomes. 40% of infants under 4 months are given some form of supplementary feeding. Workload of women does not aIlow them to prepare separate foods for their children. b) Past and present initiatives Local cereal/legume weaning food is being used nation wide. Corn miIling machines have been distributed to some communities to assist in the production of local weaning foods. Mother education on appropriate weaning practices have been on-going Appropriate weaning practices have been included in induction and in-service training programs of health and other extension workers. c) Sub-programme activities ACTIVITY TIMING RESPONSIBILITY Academic Boards of Tertiary 10.1 Review/include appropriate Institutions/Curriculum Develop weaning practices in pre-service July 1995-December 1996 ment Division (GES/MOH/MOFA curriculum of medical and allied /DCD) institutions 10.2 Include apprpriate weaning practices in induction and in-ser vice training of health and other On-going HRDD-MOH, MOFA,DCD/ extension workers GAPVOD 10.3 Design and implement a more intensive programme to educate mothers and care givers On-going NU/MCH/WIAD/DCD/HEU on the preparation and use of weaning foods 10.4 Use the participatory approach to develop appropriate and simple way to prepare Start December 1995 NU/WIAD/FRI/NMIMR/UG weaning foods of the various localities 10.5 Popularise recipes for prep aration and use of sustainable Start December 1995 DCD/GAPVOD/NCWD/WIAD/ simple weaning foods NBSSI 10.6 Establish soft loan scheme for rural women to acquire labour March 1996 GAPVOD/DCD/ITIU/NCWD saving devices NBSSI/WIAD 10.7 Identify income-generating ventures which are sustainable Start January 1996 DCD/NU/MCH/WIAD/HEU for rural women 10.8 Conduct educational progr ammes to reach the family as a Start January 1996 HEU/NU/DCD/WIAD/GA unit using radio, TV etc. 23 • National Plan of Action on Food and Nutrition - Government of Ghana 4.11 Effective Management of the NPAN ACTIVITY TIMING RESPONSIBILITY 11.1 -Estoblish multi-sectoral 'b~9Y to reflect multi-disciplinary July 1995 NDPC 'naTure of food and nutrition at appropriate levels 11 .2 Define roles and respon sibilities of all agencies/lndi- April - June 1995 ICN Task Force viduals in the NPAN 11.3 Formulate and implement March 1995 - ICN Task Force /CSPG a flexible plan of operations. December 2000 11 .4 Develop effective mechanisms to: July 1995 - CSPG • Undertake regular reviews/ December 2000 updates of NPAN indicators. • Assess, procure and control the use of resources for the NPAN • Initiate and sustain common links among all the actors of NPAN • Raise and sustain commit ment of all actors to ensure successful implementation of the NPAN 24 • National Plan of Action on Food and Nutrition - Government of Ghana Chapter 5 Costs and Financing Requirements 1. Introduction The over all cost of the NPA over a five year period as per appendix 1 summarised by table 7.1 amounts to USD 10.4 million. This excludes the cost of complementary programmes that are being funded under Water and Sanitation and Environmental Hygiene Programmes. While appendix 1 provides the schedule for specific year costs over the five year period, on an annual average basis, the NPA will cost about USD 2.0 million. Funding is available for some of the activities planned under the NPA. As per table 7.2 this amounts to USD 2.9 million. The financing gap that requires to be filled is USD 7.4 million. On an nual average basis this works out to be USD 1.48. The pattern of resource use is skewed towards training, followed by local based technical assis tance and others mainly in the area ofIEC promotion and income generation. The structure makes the NPA more of capacity building for managing Ghana's nutrition programmes on a sustainable basis. 2. Estimated Costs Of the total estimated costs of USD 10.4 million, training takes about 45%, technical assistance mostly studies and surveys to be conducted by local experts take 36% while others comprising credit schemes, supplementary feeding etc. constitute the remainder. Table 7.J Estimated Costs in usn OOOs Output Total Training Tec.Asst. Others %tage TOTAL 10408 4659 3707 2042 100% Increased Nutrient/Food Intake 1400 410 750 240 13% Improved Household Food Security 1340 345 495 500 13% Increased Sensitization of Policy Makers 306.5 101.5 160 45 3% Streng. Coord. Mech./NPA Mangement 798 104 192 502 8% Streng. Capacity for Nutrition Education 2429 1653 525 251 23% Enhanced Prevo Measures Against Nut. Dis- 511 67 395 49 5% eases Streng. Participatory Approach To F/N Prog. 388.5 128.5 230 30 4% Improved Breastfeeding/Weaning Practices 3235 1850 960 425 31% Percentage 100% 44% 36% 20% 25 " , National Plan of Action on Food and Nutrition - Government of Ghana Distribution of Estimated Costs by Output o Increased NutrientlFood Intake • Streng. Capacity for Nutrition Education • Improved Household Food Security . • Enhanced Prev. Measures Against Nut. DIseases o Increased Sensitization of Policy Makers • Streng. Participatory Approach To FIN Prog. • Streng. Coord. MechJNPA Mangement • Improved BreastfeedlngIWeanin g Practices 3500 3235 3000 2500 2000 1500 1000 500 0 Percentage Distribution of estimated Costs by Inputs • TecAssl 36% Others 20% o Training [J TecAssl • Others On the activity side breastfeeding and weaning practices combined take 31% of the total. Insti tutional capacity for nutrition education is next with 23% . Nutrient/Food intake increase and Household Food Security each takes 13%. Strengthening Coordinating Mechanisms and NPA Man agement take 8%, Preventive Measures Against Nutrition Related Diseases take 5% while Strength ening of the Participatory Approach and Sensitization of Policy makers take 4% and 3% respectively. 26 \ . ,,' • ... National Plan of Action on Food and Nutrition - Government of Ghana 2. Estimated Financing Requirements The estimated financing requirements for the NPA over the five year period is about USD7.41 million. This is depicted by table 7.2. Existing and planned programmes are funded to the tune of USD 2.998 million by the government and donors. Of the financing required, 42% is in training, 40% is in technical assistance and the remaining 18% covers others. Table 7.2 Estimated Financing Requirements Training Tee. Asst. Others Total Estimated Costs 4659 3707 2042 10408 Less: *Programmed Sources 1507 741 750 2998 Financing Gap 3152 2966 1292 7410 Percentage 42% 40% 18% 100% • Notes: For the programmed sources, 1/3 covers training. 1/5 covers technical assistance. For others credit facilities that will repaid by the beneficiaries come to USD 750,000 27 National Plan of Action on Food and Nutrition - Government of Ghana Chapter 6 8.1 Introduction Coordinating and Monitoring The government is committed to the achievement of Ghana's human development goals. To this end principles have been established to ensure that human development issues, including nutrition are inextricably woven into the fabric of development policy and underpins the design and formulation of policies and strategies for national development. The mechanism for attaining this process is contained in a document prepared by the NDPC calIed Vision 2020 (the first step). The NDPF pro vides the focus for inter-sectoral coordination and colIaboration as welI as providing opportunities for monitoring the progress of sectoral programmes. It also ensures community involvement in alI as pects of planning and execution of activities. In this later regard, the need to strengthen the links between national level policy and community based nutrition oriented programmes is assured. It is these links that wilI form the structure of the coordinating and monitoring of the NPA. 8.2 Coordination The multi-sectoral nature of the causes of malnutrition entail that an effective national nutrition programme must be multifaceted. Accordingly, activities to improve nutrition wilI require consider able cross-sectoral coordination and colIaboration. Coordination is required with respect to different tasks and different spatial levels. First there is the need for coordination at the policy formulation, planning and implementation levels. Secondly there is the need for coordination at different spatial levels, namely district, regional and national. At the national level, coordination of policies wilI be the responsibility of the NDPC Cross-Sectoral Planning Groups that have been established under law to serve this function. They would among others: coordinate policy planning and implementation with respect to nutrition cooperation with sector ministries and agencies provide guidelines/ reviews nutritional targets to be attained by the implementing institu tions. sensitise government / funding agencies on resources for executing the NPA broadly coordinate the monitoring of implementation At the regional level, Regional Planning Coordinating Units wilI play the role of the CSPG at the na tional level. Their specific functions wilI be the folIowing among others: coordinate district level implementation of the NPA advises on resource alIocation for nutritional programmes with in a regional framework At the district leveL the District Planning Coordinating Unit wilI in consultation with other key agencies: recommend programme priorities for nutrition to their respective district assemblies colIect, analyse and prepare coordinating information required by the national and regional coordinating organs. 8.3 Monitoring The programme wilI be monitored at the district, regional, ministerial/agency and national lev els. The CSPG within the confines of the national targets provide district, regional and ministerial agency targets to serve as monitoring reference. To make the system easier to operate, only output indicators wiIl be monitored 28 • . -t .. , . National Plan of Action on Food and Nutrition - Government of Ghana At the national level the CSPG will collate monitoring information from the districts, ministries and agencies. These will be reviewed firstly against the micro/district targets and then the national tar gets. At the regional level. the Regional Planning Coordinating Units will collate data from the districts into a regional monitoring format for evaluation and action At the district level. the District Planning and Coordinating Unit will gather the monitoring data from the executing units collate them, provide instant feedback where feasible and appropriate and then pass on the data to regional and national monitoring units. 8.4 Targets There is shortage of baseline information to estimate level of performance required to realise some of the objectives. Updating the current database is therefore acknowledged as an important follow up activity. To facilitate the monitoring and evaluation of the plan the following indicators will be used: 1. Adequate food/Nutrient intake for individuals Prevalence of severe protein-energy malnutrition (PEM) in school children is reduced from 8% to 4% by the year 2000 Prevalence of moderate PEM in pre-school children is reduced from 40% to 15% by the year 2000 Prevalence of iodine deficiency disorders is reduced from 33% to 10% by the year 2000 Prevalence of vitamin A deficiency reduced from x to y by the year 2000 Prevalence of iron deficiency anaemia is reduced from x to y by the year 2000 2. Improved household food security Percentage of households meeting 80% or more of recommended daily allowance of calorie and protein increased as follows: x% by 1998 and y% by the year 2000 3. Policy makers sensitised in nutrition related issues By the end of 1996 the time taken by policy makers to respond favourably to decisions on financial support for NPAIFN activities is reduced by 50% (4 weeks to 2 weeks) Budget allocation for nutrition and nutrition related activities is increased from: * x to y by 1998 * y to z by 2000 By January 1996 at least 80% of annual budget estimates for NPAIFN activities is granted by policy makers 4. Machinery for coordination among agencies involved in food and nutrition is strengthened An inter-agency coordinating body with clearly defined terms of reference is in operation by June 1996 Activities of collaborating agencies are drawn from the NPA on a routine basis after the NPA is launched 29 , . ." ,... . ' 5. 6. 7. National Plan of Action on Food and Nutrition - Government of Ghana Institutional capacity to deliver food and nutrition related education and services is improved and sustained AIl critical staffing positions in coIlaborating institutions are identified and resourced by January 1996 AIl critical logistic needs are identified and resourced by December 1996 Preventive measures against diet related diseases enhanced The incidence of diet related diseases is reduced by 10% by the year 2000 Dietary guidelines are completed and in use by 80% of the change agents by the year 2000 Increased adoption of ideal breastfeeding practices AIl hospitals/maternity facilities designated baby friendly by the year 2000 Exclusive breastfeeding for the first 6 months of life by lactating mothers increased from 8% to 65% as foIlows: * 8% to 20% by December 1996 * 20% to 39% by December 1997 * 30% to 40% by December 1998 * 40% to 50% by December 1999 * 50% to 65% by December 2000 The number of mothers who are giving breast milk with supplementation weIl into the second year to children above 6 months of age increased by 50% 8. Adoption of participatory approach to interventions in food and nutrition Projects AIl NPA/FN activities are designed and implemented using participatory methods by January 1996 9. Increased adoption of good hygiene practices by individuals Incidence of diarrhoeal diseases reduced from x to y by the year 2000 Incidence of skin diseases reduced from x to y by the year 2000 10. Increased adoption of appropriate weaning practices Percentage of mothers and care givers administering nutritionaIly balanced weaning foods from 6 months is increased from 9% to 65% as foIlows: * 9% to 20% by December 1996 * 20% to 30% by December 1997 * 30% to 40% by December 1998 * 40% to 50% by December 1999 * 50% to 65% by December 2000 11. The NPA/FN is effectively managed A plan of operations is drawn up and foIlowed Responsibilities of all parties is clear and understood Critical resource needs are delivered on schedule The objectives of the NPAN are known and understood by all the persons involved in implementation Effective trouble-shooting procedures are created and used. 30 ..'. l National Plan of Action on Food and Nutrition - Government of Ghana NPAN Cost Estimates in Quantities and Dollars (US) : 1995 - 2000 (at current prices) 1.NUTRIENT/FOOO INTAKE INCREASE Yl Y2 Y3 Y4 Y5 TOTAL Yl Y2 Y3 Y4 Y5 TOTAL Training Workshop I Seminars P/W 200 300 400 400 300 1600 0.1 20 30 40 40 30 160 Courses I Attachments P/M 100 100 100 100 100 500 0.2 20 20 20 20 20 100 Inservice Trainino P/M 200 200 100 100 100 700 0.2 40 40 20 20 20 140 Manuals I Materials No. 2000 2000 2000 2000 2000 10000 0.001 2 2 2 2 2 10 SUB - TOTAlS 82 92 82 82 72 410 Technical Assistance Short Term local P/M 40 40 30 30 20 160 4 160 160 120 120 80 640 lona Term local P/M 8 6 4 2 2 22 5 40 30 20 10 10 110 SUB - TOTAlS 200 190 140 130 90 750 Others Vrtamins I Mineral Supplement 40 30 30 20 10 130 launchinQ ofSupplementation Prooramme 20 20 Education Programmes 30 20 20 10 10 90 SUB - TOTAlS 90 50 50 30 20 240 2. HOUSEHOLD FOOD SECURITY Training Workshop I Seminars P/W 200 100 100 400 0.1 20 10 10 40 80 Courses I Attachments P/M 200 200 100 100 100 700 0.2 40 40 20 20 20 140 Inservlce TralninQ P/M 200 100 100 100 100 600 0.2 40 20 20 20 20 120 Manuals I Materials No. 1000 1000 1000 1000 1000 5000 0.001 1 1 1 1 1 5 SUB - TOTAl 81 81 51 51 81 345 Technical Assistance Short Term Intemal P/M 30 30 20 15 10 105 4 120 120 80 60 40 420 long Term Intemal P/M 5 5 5 15 5 25 25 25 75 SUB - TOTAL 145 145 105 60 40 495 Others Credit Facilities 100 100 100 100 100 500 SUB - TOTAL 100 100 100 100 100 500 3. POLICY MAKERS SENSITISATION TRAINING Workshop I Seminar I Forum P/W 100 100 100 100 100 500 0.1 10 10 10 10 10 50 Inservice Training P/M 50 50 50 50 50 250 0.2 10 10 10 10 10 50 Manuals I Materials No. 300 300 300 300 300 1500 0.001 0.3 0.3 0.3 0.3 0.3 1.5 SUB - TOTAL 20.3 20.3 20.3 20.3 20.3 101.5 Technical Assistance Short Term local P/M 8 8 8 8 8 40 4 32 32 32 32 32 160 SUB - TOTAL 32 32 32 32 32 160 Others Advocacy 20 10 30 Policy Makers Directory Compilation 15 15 SUB - TOTAL 35 10 45 4.COOROI. MECH./NPA MANAGEMENT Trainina Workshop I Seminars P/W 200 200 200 200 200 1200 0.1 20 20 20 20 20 100 Manuals I Materials No. 1000 1000 1000 1000 4000 0.001 1 1 1 1 4 SUB - TOTAl 20 21 21 21 21 104 Technical Assistance Short Term local P/M 8 10 10 10 10 48 4 32 40 40 40 40 192 SUB - TOTAL 32 40 40 40 40 192 EQuipment ComDUlers No. 3 2 1 1 1 8 10 30 20 10 10 10 80 Copiers No. 3 2 1 1 1 8 8 24 16 8 8 8 64 Typewrtters No. 2 2 3 4 4 15 0.5 1 1 1.5 2 2 8 SUB - TOTAL 55 37 20 20 20 152 Others AdvocacY/Newsletler 30 20 20 10 5 85 Nutrtlion Agencies Directory Compilation 15 15 ImplementaUoll'MonitorinQ/Evaluation Mech. 40 30 30 20 10 130 Multi-Sectoral Body forCoordination 30 30 20 20 20 120 SUB - TOTAL 155 80 70 50 35 350 31 · " , " . National Plan of Action on Food and Nutrition - Government of Ghana NPAN Cost Estimates in Quantities and Dollars (US) : 1995 - 2000 (at current prices) ,. UNIT UNIT 5. INSTITUTIONAL CAP. FOR NUT. EDU 1 1Y2 1Y3 '1'4 1V5 !TOTAL IVI 2 [Y3 [Y4 1Y5 [TOTAL Training Workshoo I Seminar P/W 300 300 300 250 180 1330 01 30 30 30 25 18 133 Inservice Training P/M 1500 1500 1500 1500 1500 7500 0.2 300 300 300 300 300 1500 Manuals I Materials No. 4000 4000 4000 4000 fiOOO 20000 0.001 4 4 4 f1 f1 20 SUB· TOTAL 334 334 334 329 ~22 1653 Technical Assistance Short Term local P/M 30 30 30 0 10 120 4 120 120 120 80 40 f180 longTerm local P/M 3 3 3 9 5 15 15 15 f15 SUB· TOTAL 120 135 135 95 40 525 Others Education Programmes 5 5 5 3 3 21 Electronic Media Campaign 10 5 5 5 5 30 Soecial Quiz Programme 50 40 40 35 35 200 SUB·TOTAL 65 50 50 43 43 251 6. PREV. MEASURES AGAINST DISEASES Training Workshoo I Seminars P/W 100 100 100 50 20 370 01 10 10 10 5 12 37 Courses I Attachments P/M Inservice Training P/M Manuals I Materials No. 6000 6000 6000 6000 6000 30000 0.001 6 6 6 6 16 30 SUB·TOTAL 16 16 16 11 8 167 Technical Assistance Short Term local P/M 20 20 20 10 10 80 4 80 80 80 f10 f10 320 lona Term local P/M 2 2 2 6 5 10 10 10 75 SUB· TOTAL 80 90 90 50 40 395 Others Education Campaign 5 5 5 2 2 19 Electronic Media Education 10 5 5 5 5 30 SUB·TOTAL 15 10 10 7 7 f19 7. PARTICIPATORY APPROACH Training Workshop I Seminars P/W 150 150 150 150 150 750 0.1 15 15 15 15 15 75 Inservice Training P/M 50 50 50 50 50 250 0.2 10 10 10 10 10 50 Manuals I Materials No. 700 700 700 700 700 3500 0.001 0.7 0.7 0.7 0.7 0.7 3.5 SUB·TOTAL 25.7 25.7 25.7 25.7 25.7 128.5 Technical Assistance Short Term local P/M 12 12 12 7 7 50 4 48 48 fi8 128 128 200 long Term local P/M 3 3 6 5 15 15 30 SUB· TOTAL 63 63 48 28 128 240 Others Advocacv 20 10 30 SUB·TOTAL 20 10 30 8.BREASTFEEDING/WEANING PRACTICES Trainlna Workshoo I Seminars P/W 400 400 f100 f100 400 2000 .1 40 f10 40 f10 f10 200 Courses I Attachments P/M 100 100 100 100 100 500 .2 20 120 20 0 0 100 Inservice Training P/M 1500 1500 1500 1500 1500 7500 .2 300 300 300 300 300 1500 Manuals I Materials P/M 10000 10000 10000 10000 10000 50000 .001 10 10 10 10 10 50 SUB·TOTAL 370 370 370 370 370 1850 Technical Assistance Short Term local P/M 60 60 50 40 30 220 4 240 240 200 160 120 ~60 SUB·TOTAL 240 240 200 160 120 ~O Others loanforrural women 50 50 50 50 SO 1250 Advocacy 50 30 20 10 5 115 Electronic Media Education 20 10 10 10 10 60 SUB·TOTAL 120 90 80 70 65 ~25 32 ... ~.tr '• .... 9' ... fI National Plan of Action on Food and Nutrition - Government of Ghana References I. 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