A rapid review of key policies and programs linked with nutrition and health in Ghana

As part of the process by the government of Ghana to develop food-based dietary guidelines, a review of policies and programs was commissioned. The review aimed to identify and describe the policy environment, with a focus on identifying the type of existing policies, priorities, and programs  related to nutrition and health between 2010 and 2020. The review also tracked the evolution of changes in policies and programs over the same  period. Using a systematic rapid scoping review approach, policy and program documents were identified and classified according to relevant  nutritionspecific and nutrition-sensensitive sectors, including health, agriculture and food, human development, social protection, and trade. Data  from included documents were extracted using an excel extraction tool. The extracted data including policies, programs, objectives, coverage of the  policies/programs, intended outcomes, target groups, and agencies responsible for implementing these policies and programs. More than 70  government documents, plus other reports and literature sources describing government policy and programs with relevance for nutrition were  identified. Most of these policies and programs were not designed to directly address malnutrition. This is because, the policies and programs  neither referenced nutrition objectives, nor nutrition outcomes. However, the existing policies and programs had aspects that can be leveraged  (either through redesign or implementation) to contribute to improved nutrition outcomes. A key challenge in the nutrition programming landscape  is the nonexistence of a comprehensive and costed national nutrition strategic plan to accompany the national nutrition policy. The key  nutrition priorities of the Government of Ghana and its partners, as expressed in the documents reviewed included infant and young child feeding,  stunting reduction, anemia, and food security. There were key nutritionrelated issues which have not been prioritized, although current local and  global evidence as well as stakeholder opinion suggests these have already become, or are rapidly becoming important priorities. These include  overweight and obesity, dietrelated chronic diseases, nutrition of school-age children, and nutrition of the elderly. These nutrition issues, if not  appropriately addressed, will continue to exact significant human health, economic, and social costs for Ghana. There is need for a comprehensive  nutrition strategy that leverages opportunities across multiple sectors to improve nutrition for today and for the future.&nbsp

A rapid review of key policies and programs linked with nutrition and health in Ghana

As part of the process by the government of Ghana to develop food-based dietary guidelines, a review of policies and programs was commissioned. The review aimed to identify and describe the policy environment, with a focus on identifying the type of existing policies, priorities, and programs related to nutrition and health between 2010 and 2020. The review also tracked the evolution of changes in policies and programs over the same period. Using a systematic rapid scoping review approach, policy and program documents were identified and classified according to relevant nutritionspecific and nutrition-sensensitive sectors, including health, agriculture and food, human development, social protection, and trade. Data from included documents were extracted using an excel extraction tool. The extracted data including policies, programs, objectives, coverage of the policies/programs, intended outcomes, target groups, and agencies responsible for implementing these policies and programs. More than 70 government documents, plus other reports and literature sources describing government policy and programs with relevance for nutrition were identified. Most of these policies and programs were not designed to directly address malnutrition. This is because, the policies and programs neither referenced nutrition objectives, nor nutrition outcomes. However, the existing policies and programs had aspects that can be leveraged (either through redesign or implementation) to contribute to improved nutrition outcomes. A key challenge in the nutrition programming landscape is the nonexistence of a comprehensive and costed national nutrition strategic plan to accompany the national nutrition policy. The key nutrition priorities of the Government of Ghana and its partners, as expressed in the documents reviewed included infant and young child feeding, stunting reduction, anemia, and food security. There were key nutritionrelated issues which have not been prioritized, although current local and global evidence as well as stakeholder opinion suggests these have already become, or are rapidly becoming important priorities. These include overweight and obesity, dietrelated chronic diseases, nutrition of school-age children, and nutrition of the elderly. These nutrition issues, if not appropriately addressed, will continue to exact significant human health, economic, and social costs for Ghana. There is need for a comprehensive nutrition strategy that leverages opportunities across multiple sectors to improve nutrition for today and for the future.&nbsp

Endemic diseases and agricultural productivity: Challenges and policy response

Contrary to Asian countries, the agricultural sector in Africa had not benefited from the green revolution success. After a long time of disinterest in the agriculture sector in Africa, several voices arise now in favour of greater efforts towards this sector. Several studies tend to show the crucial role of agriculture in African countries’ growth and highlight the huge need of increasing the productivity in this sector. If increase in agriculture productivity requires both an expansion of irrigated areas and the adoption of high yield varieties, those innovations and their high development could be the source of negative health (and environmental) effects. Using a mega-analysis, this paper highlights first the links between health, disease and development and then agricultural productivity. The literature review shows that the negative effect of bad health was not systematically checked, and that the intensity of this effect depends of the disease, but also of the work productivity and the existence or not of a coping process. The second part of the paper focused on the development of high intensive agriculture as a risk factor for farmers’ and rural inhabitants’ health. This survey shows that whether irrigation and fertilizer and pest intensive use could be considered as highly health (and environmental) risk factors, appropriate control measures (such as for examples systematic maintenance of irrigation canals, alternate wetting and drying of irrigated fields or integrated pest management) considerably reduce this risk, while at the same time, increase the agriculture productivity.agriculture, productivity, endemic disease, health risk factor, Africa

Endemic diseases and agricultural productivity: Challenges and policy response

Contrary to Asian countries, the agricultural sector in Africa had not benefited from the green revolution success. After a long time of disinterest in the agriculture sector in Africa, several voices arise now in favour of greater efforts towards this sector. Several studies tend to show the crucial role of agriculture in African countries' growth and highlight the huge need of increasing the productivity in this sector. If increase in agriculture productivity requires both an expansion of irrigated areas and the adoption of high yield varieties, those innovations and their high development could be the source of negative health (and environmental) effects. Using a mega-analysis, this paper highlights first the links between health, disease and development and then agricultural productivity. The literature review shows that the negative effect of bad health was not systematically checked, and that the intensity of this effect depends of the disease, but also of the work productivity and the existence or not of a coping process. The second part of the paper focused on the development of high intensive agriculture as a risk factor for farmers' and rural inhabitants' health. This survey shows that whether irrigation and fertilizer and pest intensive use could be considered as highly health (and environmental) risk factors, appropriate control measures (such as for examples systematic maintenance of irrigation canals, alternate wetting and drying of irrigated fields or integrated pest management) considerably reduce this risk, while at the same time, increase the agriculture productivity.agriculture;productivity;endemic disease;health risk factor;Africa

The adaptation continuum: groundwork for the future

The focus of the program was to understand the challenges posed by climate change and climate variability on vulnerable groups and the policies needed to support climate adaptation in developing countries. The aim of the book is to share this experience in the hope that it will be helpful to those involved in shaping and implementing climate change policy

Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: A qualitative study and document and record review in two regions of Uganda

Background: Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), provided as part of routine antenatal care (ANC), is one of three malaria-in-pregnancy prevention and control mechanisms recommended by the World Health Organization (WHO). However, despite high ANC attendance and increased efforts to address known obstacles, IPTp uptake figures have remained low. This study aimed to identify and assess barriers that continue to impede IPTp uptake in Uganda, in particular for women who attend ANC. The paper focuses on supply-side barriers, i.e., challenges relating to the health service provider. Methods: In-depth interviews were conducted in two regions of Uganda in November 2013 and April/May 2014 with four different target audiences: seven district health officials, 15 health workers, 19 women who had attended ANC, and five opinion leaders. In addition, a document and record review was carried out at four health facilities. Results: Guidelines with regard to IPTp provision in Uganda have been shown to be inconsistent and, at the time of the research, did not reflect the most recent WHO policy recommendation. There is a lack of training and supervision opportunities for health workers, resulting in poor knowledge of IPTp guidelines and uncertainty about the safety and efficacy of SP. ANC is not consistently offered in health facilities, leading to some women being denied services. While strengthening of the supply chain appears to have reduced the occurrence of stock-outs of SP in public facilities, stock-outs reportedly continue to occur in the private sector. There are also sources of data inaccuracy along the data recording and reporting chain, limiting policy makers' ability to react adequately to trends and challenges. Conclusions: Given the high ANC attendance rates in Uganda, supply-side barriers are likely to account for many missed opportunities for the provision of IPTp in Uganda. Improvements will require consistent provision of ANC, implementation of current WHO IPTp policy recommendations, supply of SP to the private sector, availability of clear guidelines, as well as improved training and supervision for health workers. Improving facility and district-level recording and reporting will further strengthen the country's ability to address uptake of IPTp

Water and Nutrition: Harmonizing actions for the United Nations Decade of Action on Nutrition and the United Nations Water Action Decade

Progress for both SDG 2 and SDG 6 has been unsatisfactory, with several indicators worsening over time, including an increase in the number of undernourished, overweight and obese people, as well as rapid increases in the number of people at risk of severe water shortages. This lack of progress is exacerbated by climate change and growing regional and global inequities in food and water security, including access to good quality diets, leading to increased violation of the human rights to water and food. Reversing these trends will require a much greater effort on the part of water, food security, and nutrition communities, including stronger performances by the United Nations Decade of Action on Nutrition and the United Nations International Decade for Action on Water for Sustainable Development. To date, increased collaboration by these two landmark initiatives is lacking, as neither work program has systematically explored linkages or possibilities for joint interventions. Collaboration is especially imperative given the fundamental challenges that characterize the promotion of one priority over another. Without coordination across the water, food security, and nutrition communities, actions toward achieving SDG2 on zero hunger may contribute to further degradation of the world’s water resources and as such, further derail achievement of the UN Decade of Action on Water and SDG 6 on water and sanitation. Conversely, actions to enhance SDG 6 may well reduce progress on the UN Decade of Action on Nutrition and SDG 2. This paper reviews these challenges as part of a broader analysis of the complex web of pathways that link water, food security and nutrition outcomes. Climate change and the growing demand for water resources are also considered, given their central role in shaping future water and nutrition security. The main conclusions are presented as three recommendations focused on potential avenues to deal with the complexity of the water-nutrition nexus, and to optimize outcomes

Implementing a Health Maintenance Organisation in West Africa

The purpose of this report is to determine whether health maintenance organisations (HMOs) can provide a suitable and viable form of financial health protection and service provision in selected West African countries, supplementary to existing healthcare provision and coverage. Burkina Faso, Côte d’Ivoire, The Gambia, Guinea-Bissau, Liberia and Sierra Leone were chosen as country examples. Chapter 1 provides the context for the health and healthcare situation in West Africa as well as specific country profiles, whilst Chapter 2 describes factors to be considered when establishing an HMO. The range of technical di-mensions of an HMO introduced in this report includes: administration, human resources, financing, accreditation, service availability and readiness, the benefits catalogue, paying providers, drugs and quality management. Each of these dimensions is further discussed in Chapters 3 – 10. The administration of an HMO consists of nine interconnected fields: management dash-board, quality management, IT department, purchasing and coordination, finance and ac-counting, health plan and benefit package, member management, human resources, and marketing. In Chapter 3, the authors give a more in-depth analysis of the fields of marketing and member management. Recommendations provided in this chapter include the use of different marketing approaches to bridge the gap between communities and the HMO by establishing informative advertising (e.g., via a mobile responsive website, social media, posters, flyers, radio, and recorded information). Chapter 4 focuses on an HMO’s human resources, particularly in regard to staff recruiting, development and retention. Staff development expands staff competence by increasing employees’ motivation and job satisfaction, which leads to an increase in their performance and productivity, thereby improving staff retention. Furthermore, staff retention is important for ensuring a long-term commitment to the HMO. In conclusion, the success of an HMO is crucially dependent on motivating staff and enabling them to exercise, develop and share their skills. Chapter 5 covers the financial aspects of an HMO, including dimensions related to its target population, financial barriers, funding resources, management of funds, and specific coun-try challenges. In order to calculate the necessary resources, this chapter make clear that an HMO must consider cost projections for the benefit package, infrastructure development, administration, expansion and a reserve. To establish an accreditation system, HMOs can interact with stakeholders from different fields and levels of service delivery and administration, as examined in Chapter 6. The polit-ical and social conditions of a country must be considered by the HMO in order to effective-ly implement an accreditation system. Besides this, an HMO can seek to improve the per-formance quality of healthcare by supporting the establishment of an accreditation scheme. Reliable information on service availability and readiness is necessary for successful health systems management as it allows health services to be tracked in terms of how they have responded to changed inputs and processes. In Chapter 7, the authors analyse the Service Availability and Readiness Assessment (SARA) tool, and recommend its application within the HMO, as it offers a standardised approach to monitoring the supply of services by providing a standard set of tracer indicators. To implement a health benefit package (HBP), the authors assess existing models, such as the one introduced by Glassman et al. (2017) which specifies ten core elements of an HBP design and helps to enable discussions on the most relevant aspects in designing an HBP for an HMO. Chapter 8 presents a coinsurance scheme within the HBP design which will affect the service utilisation of members as well as utilisation management as one method for cost control. In addition, actuarial calculations are proposed using Sierra Leone as a case example. Chapter 9 describes the pharmaceutical supply chain required by an HMO. Important steps of the HMO’s medicine supply chain include: selection, quantification and forecasting, pro-curement, storage, and distribution of medical products. Medicines provided by the HMO must be safe, available, accessible, and affordable at all times and for all members. Stock-outs must be avoided, and therefore this chapter recommends employing community-based health workers in order to ensure distribution to patients in rural areas. Quality management is an important field in an HMO analysed in Chapter 10 of this report. It includes patient safety, efficiency, and patient satisfaction; all factors that must be con-sidered during the implementation of an HMO. The chapter concludes by noting that quality is highly subjective and must therefore be applied to the specific context of an HMO within a specific country. Finally, Chapters 11 and 12 of the report include implementation challenges of an HMO in West Africa, as well next steps that should be followed. Although similar challenges con-cerning the social, political, or structural environment can be found in most West African countries, direct transfer of elaborated information to other countries and healthcare situa-tions is not always possible. As well as these situational challenges, HMOs encounter dif-ferent questions such as how to balance the scope of available services against the cover-age of diverse geographical areas, engagement of various stakeholders and reflection of respective values, interests and perspectives of local populations. Limitations of the report include a lack of specificity in general, and the use of many specific country settings, as observations and examples for one HMO dimension may not always be transferable to other regions and healthcare situations. Therefore, this report is not meant to provide concrete conclusions or solutions in regard to the implementation of an HMO in a specific country setting. In conclusion, this report states that HMOs have the potential to play a substantial role in healthcare system strengthening, provision of quality healthcare services and the preven-tion of financial burden due to ill-health. As a result, an HMO can support West African countries in their role to fulfil their obligation of protecting the health of their citizens. Addi-tionally, the authors strongly believe that an HMO must reflect the cultural, societal and political environment in which it is implemented. Therefore, it is essential that research be conducted prior to its implementation in addition to including the relevant local stakeholders as early as possible in the process

MDG Acceleration Framework and Country Action Plan: Maternal Health

According to the 2010 MDG Report, Ghana's progress in achieving the MDGs is mixed. The country is largely on track to achieve the MDG 1 target of reducing by half the proportion of the population living in extreme poverty. The overall poverty rate has declined substantially over the past two decades from 51.7 percent in 1991 -- 1992 to 28.5 percent in 2005 -- 2006 while the proportion of the population living below the extreme poverty line also declined from 36.5 percent to 18.2 percent over the same period against the 2015 national target of 26 percent and 19 percent respectively. Although current data on poverty is not available, trends in economic growth suggest a further decline in poverty between 2006 and 2008