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Table 2 Framework for national nutrition action for reducing nutritional deprivations in ghanathrough a data-driven planning approach

From: The lancet series nutritional interventions in Ghana: a determinants analysis approach to inform nutrition strategic planning

National Action Required Prioritized strategies
Scale up support for nutrition programs and capacity development: • Ministry of Health and Ministry of Finance to collaborate to earmark funds and budget allocation for nutritional commodities at all levels
• Integrated training plan and budget for Family Health Services including reproductive and child health, Nutrition and health promotion
• Strengthen prioritization and coordination (at higher levels) and integration of services (at lower levels) for nutritional interventions.
• Integrate nutrition into new born training package and orientation programmes for all frontline staff and newly appointed/posted staff to both public and private health facilities and maternities
• Revise and implement pre-service curriculum to enhance the practical skills of frontline workers in nutrition services
• Strengthen active surveillance on severe acute malnutrition within the communities and increase frequency and intensity as well as targeting of cases of severe acute malnutrition with social mobilization activities.
• Task sharing/shifting to other health care workers who traditionally have not been involved in nutrition services to expand the base of coverage (e.g. physicians assistants, enrolled nurses and midwifes), especially in the District Hospitals
• Capacity building (training and supervision) for frontline health staff nutrition counselling and support at all levels through provision of resources (counselling cards, child health record booklets, registers)
Mobilize key stakeholders in an inclusive approach to ownership and demand for services • Leverage on existing community platforms for community based intervention (e.g. exclusive breastfeeding and infant and young child feeding) advocacy activities (faith based organizations, community groups, women groups etc.).
• Increase community participation in nutritional intervention especially breastfeeding and young child feeding through targeting other family members with decision making in breastfeeding (in-laws, grandmothers, peers, husbands)
• Community dialogue meetings/sensitization, targeting key family and community stakeholders (Traditional, Religious and opinion leaders) on effects of social norms on nutrition and health of the young child
• Engage Community Health Committees and other community based organizations as well as targeting family, traditional and religious leaders to create demand for Focus antenatal services where the women will receive the supplements- Iron, Folate and Vitamin A Supplementation
Provide guide to co-ordinate work of stakeholders and partners • Develop and implement uniform data collection forms and registers for use in all health facilities and by partners
• National and regional levels to develop factsheets/key messages on complementary feeding, educational materials on control of anaemia and micronutrient deficiencies for frontline health workers and community based volunteers.
• Regular engagement of partners to streamline activities at national and sub-national levels, during health summit and review meetings.
Develop strong, prioritised national strategies • Create a simplified register and incorporate essential nutrition indicators (Iron, Folate and Vitamin A Supplementation) into routine health information reporting system (DHIMS) to strengthen service monitoring
• Review current social mobilization strategy on severe acute malnutrition to specifically include essential elements such as diet frequency, target groups, inimical social norms, and specific workable service delivery platforms.
• Strengthen linkages and communication between health workers within health facilities and volunteers working at and within the communities- to engender prompt referrals and enrolment into care for children with severe acute malnutrition
• Work schedule re-organization and task sharing at the health facility level to free time for sufficient and effective nutritional counselling by frontline workers.
• Strengthen inter-sectoral collaboration- Ministry of Health and Ministry of Agriculture to increase involvement of agriculture extension in family or community farming activities
Pay attention to inequities and special needs regions and geographical areas • Strengthen data validation, monitoring and supervision of frontline workers (Community health workers) at the decentralized level especially in regions and geographical areas with worse indicators
• District health teams to be tasked and appraised on coordination and management of malnutrition services at the district and sub-district level
• Health facility managers to enforce the implementation of the policy on free treatment for Children under-5 years at all levels of the health system to engender service uptake in poor rural areas of the country.
Support with evidence, demonstrable gains in service delivery • Good quality data are essential for effective planning and analysis, and data validation to improve data quality and accuracy is a core activity to be undertaken by all levels
• Build capacity of regional, district and sub-district on the application of data driven planning tools (Bottleneck Analysis/Determinants Analysis Approach is one means of achieving this)
• Create supportive environment for nutritional surveys (national and sub-national level) with participation of partners. Hitherto, nutritional surveys have been limited to the national level.
Support advocacy for addressing undernutrition: • Advocacy for improvement of Early Initiation of Breastfeeding in both public and private health facilities and maternities
• Advocacy with National health insurance authority to adopt Baby Friendly Health Facility Initiative as one of the criteria for accreditation of health facilities in the country.
• Advocacy at the national level for the application of E-platforms for teaching and learning in nutrition by pre-service institutions to enhance efficiency and quality of training