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Field Article
Health and nutrition policies
The National Nutrition Policy is currently being
drafted 4 . Prior to the development of the
national nutrition policy, a strategic document
‘Imagine Ghana free of Malnutrition 5 ’ was
developed by a multi-sectoral group of stakeholders.
The document set out strategic
nutrition objectives and provided costing for
implementing nutrition interventions to meet
the set objectives. This document is currently
being used as the basis for the nutrition policy,
updating and aligning Ghana’s nutrition priorities
to address under-nutrition using
evidence-based nutrition interventions.
The Ghana Health Sector Medium Term
Development Plan (HSMTDP) 2010–2013 and
the Ghana Shared Growth and Development
Agenda (GSGDA), which is a follow on document
to the Ghana Poverty Reduction Strategy
II (GPRS II), identify nutrition and food security
as critical and cross-cutting issues in addressing
overall human resource development. The
GSGDA sets out policy objectives to address
issues relating to nutrition and food security.
Both aforementioned documents express
particular concern regarding the persistent and
high undernutrition rates among children,
particularly male children in rural areas and in
northern Ghana. The HSMTDP identifies the
scale up of CMAM as an important intervention
for helping to reduce under five mortality rates
and also for improving the nutrition status of
women and children.
Vulnerability to emergencies
The Comprehensive Food Security and
Vulnerability Analysis conducted by the World
Food Programme (WFP) in May 2009 showed
that, although Ghana is generally less affected
by food insecurity compared to other West
African and sub-Saharan countries, about 1.2
million Ghanaians are food insecure. A further
2 million people are vulnerable and could experience
food insecurity during adverse weather
conditions, such as floods or droughts, and as a
result of post-harvest losses. Although the
prevalence of acute undernutrition is below
emergency thresholds, nutritional challenges
threaten Ghana’s overall social and economic
development. There are regional variations in
food security and undernutrition in the country.
The Northern regions (Upper East, Upper West,
and Northern) have a higher prevalence of
underweight and wasting that are closely
linked to food insecurity. Lack of access to food
is also a determining factor for acute undernutrition
in the coastal zone.
Organisation of the Ghana Health System
(GHS)
The Ministry of Health (MOH) is the government
ministry in Ghana that is responsible for
the formulation of national health policies,
resource mobilisation, and health service delivery
regulation. The MOH has a number of
agencies, including the Ghana Medical and
Dental Council, the Pharmacy Council, Ghana
Registered Nurses and Midwives, Alternative
Medicine Council, Food and Drugs Board,
Private Hospitals and Maternity Homes Board,
National Health Insurance Secretariat, Ghana
National Drugs Programme, teaching hospitals
and the Ghana Health Service (GHS). See
Figure 2 for an overview of the GHS structure.
The GHS is an autonomous body under the
MOH, responsible for healthcare provision in
accordance with MOH policies through public
Figure 2: Ghana Health Services organisation structure
Family Health
Division
Reproductive
and Child
Health
Department
Health
Promotion
Department
Nutrition
Department
Public Health
Division
Disease
control
Department
Disease
Survillance
Department
Policy, Planning,
monitoring and
evaluation
Policy
Department
Planning and
Budgeting
Department
Health
Administration
and support
services
Clinical
engineering
Department
Estate
Management
Department
Transport
Management
Department
hospitals, health centres, and Community
Health Planning Services (CHPS) compounds.
The GHS provides in-service training and develops
guidelines and plans for implementation of
national health policies. Private and faith-based
health facilities, such as mission hospitals,
administer approximately 40% of healthcare
services in the country. While independent,
these facilities are bound by national MOH policies
and GHS guidelines and are required to
submit statistics and reports to the GHS.
The Family Health Division under the GHS
has three departments: Reproductive and Child
Health, Nutrition, and Health Promotion. The
Nutrition Department assigns Programme
Officers for the various nutrition programmes
such as Infant and Young Child Nutrition
(IYCN), Nutrition Malaria Control for Child
Survival Project (NMCCSP), Micronutrient
Control Programme, which covers vitamin A,
iron deficiency anaemia, iodine deficiency
disorders and food fortification, Nutrition
Rehabilitation, which includes CMAM and
Nutrition Assessment Counselling and Support
(NACS) for PLHIV, and the Supplementary
Feeding Programme (SFP) in Northern Ghana.
At the regional and district levels, there are
assigned nutrition officers, while at the subdistrict
levels a health manager (Physician
Assistant or Public Health Nurse) oversees
nutrition activities along with other health
activities.
Health services delivery
There are three semi-autonomous referral
teaching hospitals, one each in the northern,
central and southern parts of the country. There
are ten regions of Ghana, divided into 170
districts, and each region has a regional referral
hospital. All districts are expected to have a
district hospital, which serves as the first referral
level. However, some of the newly created
districts have upgraded health facilities rather
than hospitals, due to variations in levels of
staffing and equipment. Districts are further
divided into sub-districts, which have health
centres headed by Physician Assistants and
staffed with clinical and public health nurses
and other auxiliary staff. Some of the larger
urban health centres, referred to as polyclinics,
are staffed with physicians in addition to the
personnel mentioned above. Additionally, there
are 42 Nutrition Rehabilitation Centres (NRCs)
that were established to manage malnutrition
prior to the introduction of CMAM. Ten of the
Director General
Deputy Director
General
Human
Resource
General
Administration
Department
Institutional
Care
Internal
Audit
Finance
Research and
Development
Supplies
Stores and
Drug
Management
Office of
Director
General
NRCs provide residential nutrition care. NRCs
tend to be clustered in more urban areas.
Administratively, the GHS is managed at the
regional and district level by health directorates.
Beyond the sub-district level, community
level health services are provided through
different mechanisms. Two of the more developed
mechanisms include child welfare
outreach points (run from health centres) and
CHPS zones. The CHPS zones comprise
communities of 3,000 to 4,500 people (generally
two to five villages), to which a community
health officer 6 (CHO) is assigned to provide
primary health care services from the CHPS
compound (the nurse’s home and office, built
by the community) and through frequent home
visits. The CHO is supported by a number of
community health volunteers (CHVs) selected
by a community health committee, comprised
of village leaders, women’s and youth groups,
traditional birth attendants and others.
Across the different levels of service delivery,
health staffing is generally adequate with
exceptions in newly formed districts. The
Northern regions also tend to have fewer physicians
and nurses compared to the southern and
central parts of the country because these
regions are less developed.
CMAM integration and scale up in Ghana
Introduction of CMAM
CMAM was first introduced in Ghana in June
2007 at a workshop organised by the GHS in
collaboration with UNICEF, WHO and USAID
for selected health care providers throughout
the country. See Table 1 for an outline of key
events in the development of CMAM in Ghana.
Prior to 2007, the GHS had addressed the needs
of children with severe acute malnutrition
(SAM) in paediatric wards or NRCs, which
provided nutrition counselling and foods
cooked using locally available ingredients.
However, these NRCs did not follow the WHO
1999 treatment protocol for the management of
SAM 7 or provide any specialised therapeutic
foods for children with SAM.
4
As at November 2011.
5
‘Imagine Ghana Free of Malnutrition’, NMCCSP Programme
supported by the World Bank
6
A Community Health Officer is a Community Health Nurse
or Midwife who receives additional training, upgrading
his/her skills to manage a CHPS zone.
7
WHO. 1999. Management of severe malnutrition: A manual
for physicians and other senior health workers.
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