Nutrition
From donor dependence to national ownership: Ghana’s path to sustainable child nutrition
An estimated 68,517 children in Ghana currently suffer from Severe Acute Malnutrition, yet only about 15 percent receive treatment. This gap is not due to a lack of effective solutions, but to limited and unstable access driven by fragmented, donor-dependent financing. As Ghana advances toward universal health coverage and economic self-reliance, ensuring sustainable and equitable child nutrition services requires urgent policy action.
Ready-to-Use Therapeutic Food (RUTF) and Multiple Micronutrient Supplements (MMS) are proven, cost-effective interventions. RUTF achieves recovery rates of 75–90 percent among children with severe acute malnutrition, while MMS reduces low birth weight and preterm birth. Both interventions are included in Ghana’s Essential Medicines List and Standard Treatment Guidelines. National protocols are finalised and disseminated, and over 600 health workers have been trained. In short, Ghana has laid the policy and technical groundwork.
Despite this readiness, access remains constrained by reliance on donor funding. Time-bound financing leads to supply disruptions, uneven geographic coverage, and weak long-term planning. Service availability often reflects donor priorities rather than population need.
Most critically, national ownership is undermined when lifesaving child nutrition interventions depend on external support. Donor dependence also limits system integration. Nutrition services delivered through projects remain peripheral to routine care. Health facilities cannot fully integrate RUTF and MMS into standard maternal and child health services without predictable supply. Data systems, quality assurance, and accountability mechanisms remain fragmented, preventing these interventions from reaching scale and impact.
Integrating RUTF and MMS into the National Health Insurance Scheme (NHIS) offers a clear pathway to sustainable national ownership. With 84 percent of mothers of children under five already enrolled, NHIS provides an existing platform for rapid and equitable scale-up. The 2025 uncapping of the National Health Insurance Levy further strengthens the financing base. NHIS inclusion would remove out-of-pocket costs for vulnerable families, standardise service delivery nationwide, and embed nutrition care within routine health services.
The cost implications are manageable. MMS costs approximately USD 2.50 per pregnancy for a full course, representing a small fraction of current undernutrition spending. Timely community-based RUTF treatment also reduces costly hospital admissions for complicated and severe malnutrition. Ongoing Health Technology Assessments will provide Ghana-specific evidence to guide reimbursement decisions.
Domestic financing brings broader benefits. It ensures stronger government accountability, improved data reporting, better quality assurance, and long-term planning beyond donor cycles. Most importantly, it affirms that the survival and wellbeing of Ghanaian children are national responsibilities.
The policy decision before Ghana’s leadership is clear. The clinical evidence supports RUTF and MMS. The regulatory framework is established. The implementation capacity exists through trained health workers and operational guidelines. The financing mechanism is available through NHIS with its recently expanded revenue base. What remains is the political committment to prioritise sustainable nutrition financing as part of Ghana’s Universal Health Coverage roadmap and broader development agenda.
Donor support has been valuable in establishing these interventions and building implementation capacity. The transition to domestic financing should be viewed not as disengagement but as graduating to full national ownership. Development partners can continue supporting technical assistance, capacity building, and innovation while Ghana secures sustaining coverage at scale.
The gap between 15 percent coverage and the 80 to 90 percent achievable with adequate financing represents thousands of preventable child deaths and compromised maternal health outcomes annually. Closing this gap through NHIS integration of RUTF and MMS is not merely a technical health financing decision. It is a statement of national values and priorities, affirming that every Ghanaian child deserves access to lifesaving nutrition treatment regardless of circumstance. It is a foundation for sustainable human capital development.
Feature article by Women, Media and Change under its Nourish Ghana: Advocating for Increased Leadership to Combat Malnutrition project.
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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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Cornmeal doughnuts also known as Bamfo bisi or Awiesu is a very delicious Ghanaian snack and street food. The snack is crunchy and can make one full.
Ingredients
- 2 cups of milled corn flour
- 3 tablespoonful of grounded nutmeg
- Half cup of sugar
- 1 litre of oil
- Half cup of roasted groundnut
Preparation
- Pour one cup of the corn flour into a saucepan and mix with water.
- Place the mixture and heat for about 4- 9 minutes until a smooth paste is formed.
- Set mixture aside to cool
- Pour the remaining one cup of flour into a large bowl.
- Add sugar, nutmeg and stir together.
- Scoop and transfer the hot paste into the dry corn flour.
- Roll the dough between your palms to form an oblong shape with clean hands and insert peanuts.
- Pour cooking oil into a pot until well heated.
- Fry the Awiesu until gold
By Linda Abrefi Wadie
