How the National Nutrition Policy was translated into local action in Ghana (Story of Change)

In Ghana, a National Nutrition Policy was established to combat malnutrition. Yet, Nanumba North, a large municipality with high rates of malnutrition, had not implemented this policy at the local level. Grameen Ghana, a partner of the Voice for Change Partnership (V4CP) and a reputable civil society organisation (CSO) in the region, decided to bridge the gap. Similarly, the Ghana Trade and Livelihood Coalition (GTLC), V4CP partner in Wa West District, facilitated the creation of a community-based nutrition committee to address this gap. Through evidence-based advocacy and the support of V4CP coaching, Grameen and GTLC brought a range of actors together for a coordinated and sustainable approach to tackling malnutrition in their respective areas.

On 21 May 2019, a group of thirteen notable actors gathered together at Nanumba North’s Municipal Assembly Hall in Bimbilla, Ghana. The conference room where they met was alive with excitement. For most, greetings and introductions were not necessary – many had met and worked together before. However, this was the first time that this group of individuals were all meeting to work together to achieve a common goal: the improvement of nutrition service delivery in Nanumba North Municipality. Under the title of “Nutrition Technical Team” (NTT), these thirteen committed representatives would work to increase coordination between their respective institutions and create a sense of collective responsibility to address nutrition issues in their municipality. Mugmin Musah, Head of Programmes of Grameen Ghana, a local organisation dedicated to reducing poverty especially in the poorest regions of Northern Ghana, had been facilitating the meeting that day. He watched with pride as the NTT was officially inaugurated by the Municipal Coordinating Director. This was a monumental step to improving nutrition in his municipality, and it had been a long time in the making.

A National Nutrition Policy, but no local action: why?

Three years prior to the successful inauguration of the NTT in Nanumba North, the Ghanaian government had launched the National Nutrition Policy (NNP) in Accra. The national policy intended to enhance the focus on nutrition across the country. Its objective was to ensure high coverage of nutrition-sensitive interventions and enhanced coordination between institutions that address nutrition.

Despite the large-scale national launch of the NNP, there was little to no awareness of the national government’s ambition to address nutrition in many municipalities, including Nanumba North, a large municipality with severe malnutrition challenges. Many of the stakeholders in the food and nutrition security sector had not heard of the NNP nor seen the document, and many in the community, including important stakeholders like the Ghana Health Service, did not consider nutrition to be a real priority. The activities that were being carried out to address malnutrition in Nanumba North by government departments and stakeholders were done in silos, irrespective of each other’s activities and with insufficient coordination. A range of issues led to inefficient and ineffective nutrition service delivery. Mixed messaging left many people confused, such as when the Ministry of Agriculture promoted cash crops while the Ghana Health Service promoted other nutritious crops. There was often an overconcentration of activities in one area and little to no work in another, as well as a lack of clarity regarding roles and responsibilities across the institutions involved.

The NNP aimed to fix these poor coordination and service delivery problems. However, this would prove challenging given that the local bodies that were supposed to comply with the NNP were unaware of the policy. There was a lack of understanding of the importance of nutrition, which meant that the issue was not prioritised.

Grameen Ghana, one of the V4CP programme’s partner CSOs, saw the potential of the NNP and the positive impact it could have for Nanumba North Municipality. A large municipality where Grameen Ghana was already considered a reputable actor in the field of nutrition, Nanumba North presented a real opportunity to make an impact with the implementation of the NNP, and to inspire other districts or municipalities to do the same. Coordination between the different institutions would be improved through the creation of Nutrition Technical Teams, as proposed by the NNP, and it would reprioritise the issue of nutrition within the communities.

Grameen therefore decided to link all their advocacy work to the NNP to provide a strong foundation for their work.

According to Mr. Mugmin Musah:

"When local-level government institutions would question why Grameen was pushing for the prioritisation of nutrition, we could simply respond, “This is not our policy, it is your own! We are just supporting you to implement what has been outlined in the NNP”. It’s difficult to argue with that line of argumentation.” – Mr. Mugmin Musah, Head of Programmes, Grameen Ghana

Raising awareness and prioritising nutrition at Municipal level

Grameen’s advocacy goal was set: it would push for the establishment of a Nutrition Technical Team to improve coordination amongst the District’s actors. According to Mr. Musah, “the committee is mandated to identify gaps in the nutrition service delivery and advise Assembly and recommend further research to address key issues that affect the people.”

The first step was to conduct a stakeholder mapping exercise, through which it identified that a lack of awareness of the NNP’s existence was far-reaching amongst relevant stakeholders. Apart from the Ghana Health Service, government institutions (including the Department of Agriculture and the municipal assembly) were unaware of the national-level policy that had been launched by their very own organisations at national level.

Grameen made a conscious decision to spend the first year of the programme focusing its efforts on increasing stakeholders’ understanding of nutrition and of the NNP. The CSO relied on existing literature to explain to stakeholders the importance of nutrition. It gathered this research with the support of the International Food Policy Research Institute (IFPRI), partner of V4CP. Grameen also worked with the government’s Regional Nutrition Officer to disseminate information on the NNP and the policy recommendations it made beyond its own municipality. As the Regional Nutrition Officer has direct access to a large majority of nutrition-focused stakeholders, collaboration ensured that the municipality’s health centre staff, the Municipal Assembly, private service providers, and others would then pass on this information directly to their communities.

In Grameen’s personal engagements, it made an active effort to talk about the NNP and highlight the municipality’s nutrition issues every chance they had. If you had been in Nanumba North Municipality in late 2016 or early 2017, you may have heard Grameen talking on radio shows about the importance of nutrition, at community-level durbars, dialogue meetings, round table discussions, and on TV. Grameen was determined to ensure that the NNP would not be another ambitious policy that collected dust on a shelf somewhere.

Through its personal engagements, Grameen also learned how to engage stakeholders who had withdrawn from dialogue sessions as a result of being faced with difficult and challenging questions by CSOs and nutrition service recipients. Working with the V4CP coach, Grameen learned the importance of informal engagements in order to reconnect with officials and to begin establishing common ground. It learned how to encourage an organisation to move away from a defensive demeanour to one that is open to feedback and collaboration, considering Grameen today as a strategic partner.

By June 2017, stakeholders across the municipality had gained a thorough understanding of the nutrition issue and how important it was for it to be addressed. As a result of Grameen’s hard work, many were now also familiar with the NNP and the framework it provided to address the issue of nutrition. At a nutrition policy forum that month in Bimbilla, the capital of Nanumba North District, the Northern Regional Nutrition Officer stated, “We have realised that issues of nutrition are [sic] a challenge in the region, particularly in Nanumba North District, and this forum is important because of the involvement of key stakeholders on nutrition so that we can all participate in monitoring the implementation of the [National Nutrition] Policy.”

This shift in understanding and recognition helped Grameen to gain momentum in their advocacy work. That month, the Co-ordinating Director and Planning Officer of the Nanumba North Municipal Assembly (NNMA) committed to collaborating with Grameen to improve the planning and implementation of the NNP in the Municipality. Soon after, the Municipality’s Director of the GHS committed to collaborating with Grameen followed by the Municipal Assembly agreeing to work closely with Grameen and stakeholders to improve the implementation of the NNP. Grameen’s hard work was beginning to bear fruit.

From awareness to action: creating a sustainable Nutrition Technical Team

With the support of Nanumba North’s key stakeholders confirmed, the next challenge for Grameen was to convince the municipality’s nutrition actors to establish a Nutrition Technical Team (NTT). The NTT is a multi-stakeholder group prescribed by the NNP that brings all relevant stakeholders working in the field of nutrition together to coordinate their activities. These stakeholders range from the health directorate to information services and private sector actors, and all influence and/or implement nutrition activities. As the NTT requires the participation of a large number of different stakeholders, Grameen pursued a long-term and holistic advocacy strategy that focused on sensitising these organisations to commit to the establishment of the NTT.

Finally, in August 2018, Grameen’s patience and hard work began to pay off. After over a year of dialogue with stakeholders, the very influential Municipal Coordinating Director agreed to meet with Grameen and discuss their plans for the establishment of the NTT. The Municipal Coordinating Director is the municipality’s administrator; he determines where municipal money goes, with all cheques written in his name. Grameen presented the work they had been doing under the V4CP programme and convinced the Director, his deputy, and the Planning Officer of the important role that the NTT could play in improving nutrition service delivery across the municipality. With their support, Grameen had passed the largest hurdle, and now it was simply a matter of time before the first NTT would be established in Nanumba North Municipality. The municipality’s coordination challenges were on their way to being resolved.

From its many years of experience, Grameen had learned that creating a new body did not automatically mean it would function effectively and be accountable. To avoid this possible pitfall, Grameen strategically proposed for the NTT to be linked to a longstanding body that was operating effectively and had gained credibility within the municipality; namely, the Municipal Planning and Coordination Unit (MPCU). The link between the NTT and the MPCU came in the form of a progress report by the NTT which would be a standard part of the MPCU’s agenda. By making the reporting of NTT activities mandatory, it would ensure that the NTT would meet on a quarterly basis, before every MPCU meeting, and thus function effectively. The Municipal Director listened to Grameen’s proposal and, impressed, the MPCU officially formed and inaugurated the NTT in May 2019.

Grameen’s hopes for the future: horizontal and vertical scaling

A few months since the inauguration of the NTT, the success achieved by Grameen and Nanumba North Municipality is already generating interest in neighbouring districts and municipalities. Representatives of Nanumba South requested Grameen’s support in helping them generate interest in establishing a NTT in their district. Meanwhile at a Regional Committee meeting, the Nanumba North representative’s relaying of developments in his municipality led to questions being raised whether the same NTT should not be formed at regional level. Seeing as Ghana’s North region is made up of sixteen districts and has a population of about 2.5 million, Grameen’s work and dedication may have a significant knock-on effect at both horizontal and vertical levels.

While the NTT’s work is still in its early stages, its establishment has already had a positive impact. This process confirmed civil society’s legitimacy by turning words into action. By building relationships with multiple stakeholders, it managed to secure its seat at the table. Thanks to civil society, diverse members of the community are rallying behind the issue of malnutrition and are keen to resolve the problem together. At last, they have a vehicle in place to drive it forward.

Scaling horizontally: The Poyentanga Nutrition Committee in Wa West District

Like Grameen’s advocacy approach in Nanumba North, the Ghana Trade and Livelihood Coalition (GTLC), a partner of V4CP, facilitated the creation of a community-based nutrition committee in order to improve the implementation of the National Nutrition Policy.

Wa West District faces acute rates of malnutrition and insufficient availability of health workers and centres to support the community. To analyse the problem, GTLC, with the support of V4CP, adopted a multi-stakeholder approach, and noted the lack of coordination among different actors.

GTLC facilitated town hall meetings to discuss the role of communities in the implementation of the National Nutrition Policy.

The traditional chief of Poyentanga, Naa Abdulai Salia, said, “During the community town hall meeting organised by GTLC, we were told about the devastating effect of malnutrition. That made us to think that something could be done. Hence, we came out with the nutrition committee, to find solution to our own problem”.

In November 2018, the Poyentanga Nutrition Committee was inaugurated, representing a big step forward in the improved implementation of the National Nutrition Policy. It convenes a diverse set of actors and promotes coordination with the different segments of the Poyentanga community with respect to nutrition.

So far, te newly established committee has started engaging with the Wa West District Assembly to establish the mandatory District Technical Nutrition Subcommittee which ensures that nutrition is prioritised in the district.  Its mandate is to observe, document cases of malnutrition and use that as evidence to engage with the local authorities to find solutions to the problem.

Who we are

The Voice for Change Partnership (V4CP) strengthens the capacities of CSOs to foster collaboration among relevant stakeholders, influence agenda-setting and hold the government and private sector accountable for their promises and actions. It is funded by the Dutch Ministry of Foreign Affairs.