Nutrition
Beyond Pilot Projects: Why Ghana needs sustainable financing for nutrition at scale
Ghana has made important progress in testing effective nutrition interventions. Multiple Micronutrient Supplements (MMS) have been piloted in selected health facilities across several districts, reaching thousands of pregnant women.
Ready-to-Use Therapeutic Food (RUTF) has been delivered through community programs in high-burden districts, supported by trained health workers. These initiatives demonstrate that proven nutrition interventions can be implemented successfully within Ghana’s health system.
However, pilot projects are designed to test feasibility, not to meet national needs.
Despite their success, current pilots reach only a small fraction of the women and children who require these services. Meanwhile, anemia affects a large proportion of pregnant women, and tens of thousands of children suffer from severe acute malnutrition each year. The gap between pilot coverage and population need highlights the limits of project-based approaches.
Nutrition projects funded through time-bound grants face predictable constraints. Coverage depends on donor priorities rather than national burden. Programs end when funding cycles close, even if needs persist. Financing uncertainty makes long-term planning difficult, and supply chains often remain fragmented instead of being integrated into national systems. Data collection and accountability focus on project requirements rather than strengthening national monitoring.
Most critically, project-based approaches perpetuate inequity. Women and children in pilot districts receive evidence-based interventions while those in non-pilot areas with identical needs receive outdated or no care. Access becomes a matter of geography rather than health policy. This creates a two-tier system where donor program placement, not health policy, determines who receives lifesaving treatment.
Systems-based financing through the National Health Insurance Scheme offers a fundamentally different approach. NHIS integration ensures nationwide coverage based on enrollment rather than project geography. With 84 per cent of mothers with children under five already enrolled, the delivery infrastructure exists.
Financing becomes predictable through established NHIS revenue streams. Supply chains integrate with national pharmaceutical procurement systems. Quality standards and accountability mechanisms operate across all facilities, not just pilot sites.
Transitioning from pilot to scale requires policy decisions that projects alone cannot deliver. RUTF and MMS must be formally included in NHIS benefits and medicines lists. Reimbursement rates must be established to cover procurement and distribution. Budget allocations must be protected within medium-term expenditure frameworks. Supply chains must be strengthened at national level rather than replicated across multiple projects.
Ongoing Health Technology Assessments will deliver crucial evidence about cost-effectiveness to guide future decisions. Available data already suggests that MMS is highly affordable within public-sector financing, while community-based treatment of severe malnutrition reduces reliance on costly hospital care. These interventions are not only effective, but they are also fiscally realistic.
Pilots have served their purpose. Continuing to operate at pilot scale when national implementation is feasible means accepting preventable illness and loss of human potential. Ghana has the policy frameworks, trained workforce, and financing mechanisms required to move forward. What remains is the decision to shift from demonstration to delivery, and to ensure that effective nutrition interventions reach everyone who needs them.
Feature article by Women, Media and Change under its Nourish Ghana: Advocating for Increased Leadership to Combat Malnutrition project.
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Countries that have made significant progress in reducing malnutrition tend to follow similar paths. Their experiences from Asia to Latin America and across Africa offer useful lessons for Ghana as it works to move nutrition interventions from small pilot programs to nationwide coverage.
One of the most consistent factors is strong political commitment at the highest levels of government. In countries that achieved progress, malnutrition was treated as a national development priority rather than only a health-sector issue. Political leaders publicly championed nutrition, established coordination mechanisms across ministries, and protected nutrition budgets even during periods of fiscal pressure. This high-level ownership translated into multi-sectoral action across agriculture, health, education, and social protection.
Another common feature is the transition from donor dependence to domestic financing. Successful countries deliberately built sustainable funding mechanisms for nutrition programs. Some established dedicated government budget lines to ensure spending could be tracked and protected. Some earmarked specific revenue streams for nutrition programs. Others integrated nutrition services into national health insurance systems or broader social protection programs. These transitions typically occurred gradually over several years, with clear milestones and accountability mechanisms.
Integration with existing health systems proved more effective than creating parallel structures. Countries that embedded nutrition services within primary healthcare platforms achieved better coverage and sustainability than those relying on standalone programs. Integrating nutrition protocols into routine health worker functions, incorporating nutrition indicators into standard reporting systems, and using existing supply chains for nutrition commodities reduced implementation costs while strengthening overall health system capacity.
Community-based approaches consistently outperformed facility-based models for treating acute malnutrition. Over 70 countries have adopted community management using RUTF, allowing most children with uncomplicated severe acute malnutrition to be treated at home and achieving recovery rates of 75 to 90 percent. This approach reduces costs compared to hospital treatment while reaching more children. The shift from inpatient to outpatient care represents one of the most significant advances in nutrition intervention delivery over the past two decades.
Strong data systems also play a vital role. Countries that made progress invested in integrating nutrition monitoring into national health information systems rather than relying solely on periodic survey mechanisms. Real-time data on service coverage, commodity availability, and outcomes enabled rapid problem-solving and course correction. Regular public reporting created accountability pressure that sustained implementation quality.
Another important lesson is focus. Countries that achieved results concentrated resources on a small set of proven interventions, scaling them nationally before expanding to additional initiatives. This disciplined approach prevented the fragmentation that often occurs when many small programs compete for limited resources.
Ghana today stands at a similar point to where many successful countries once stood. The policy frameworks exist. Proven interventions such as Ready-to-Use Therapeutic Food and Multiple Micronutrient Supplements are included in national guidelines. Health workers have received training, and pilot programs demonstrate that implementation is feasible.
Global experience shows that the next step is not waiting for perfect conditions. It requires deliberate decisions on sustainable financing, continued political leadership, and integration of these interventions into existing national systems. Countries that took these steps were able to move from pilot projects to nationwide impact.
Feature article by Women, Media and Change under its Nourish Ghana: Advocating for Increased Leadership to Combat Malnutrition project
Ingredients
–2 tablespoonfuls of dawadawa
-2 pounds of chicken
-Pepper to taste
-Salt to taste
-2 large green pepper
– 1 tablespoonful of ginger
– 1 litre of oil
-5 large tomatoes
-Tomatoe puree
-1 tablespoonful of nutmeg
-1 tablespoonful of curry
Preparation
-Cut the chicken into desirable sizes and wash into a saucepan
-Add blended onion, garlic and ginger
-Add salt, seasoning and allow to steam for 5-10 minutes
-Heat oil in a large saucepan. Allow chicken to cool and fry until golden brown and transfer to separate bowl
-Add onion and pepper
-Add fresh tomatoes and tomatoes puree. Stir and cover to cook.
-Cut dawadawa into smaller sizes, grind and pour into stew.
-Add curry, nutmeg and rosemary
– Add salt and seasoning to taste
By Linda Abrefi Wadie
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