When I first saw the marked reduction in stunting in the 2011 Multiple Indicator Cluster Survey in Ghana, I was pleasantly surprised. In fact, most partners had doubted the findings and eagerly waited for the next national Demographic and Health Survey in 2014 to confirm the trend.
But indeed, Ghana has reduced stunting even further to 19 percent, thus nearly halving the rate reported in 2003 and exceeding rates of stunting reported by many countries in Sub-Saharan Africa.
The improvements are in both urban and rural areas, and show a marked closing of gaps between richest and poorest quintiles. Ghana is “on track” for four of the six World Health Assembly indicators for nutrition, with significant efforts needed to address low birth weight, anaemia and obesity in adults.
How did Ghana improve stunting? The results we are seeing reflect progress in multiple sectors some of which I’d like to highlight.
First and foremost, science tells us that for children to grow well, each day they must be fed a variety of foods frequently, they must be protected from infections, and if they do get ill they must have early access to appropriate health care. When these practices are promoted well by the health system during the first 1000 days of life, chances of reducing stunting are very high. An important factor linked to the success in Ghana is the scaling up of community health care services even in hard-to-reach areas, with full health insurance coverage. According to the latest national survey 87 percent of women have at least four antenatal care visits. Regular health facility visits ensure that mothers get appropriate information on health and nutrition during pregnancy, delivery and after birth.
In my 23 years career with UNICEF, I have not seen any other country in Africa that has invested in trained nutrition professionals in the health system as is the case in Ghana, which helps to plan, deliver and monitor quality nutrition programmes.
I have also observed that besides the wide reach of community health care services, nutrition programmes in Ghana have benefited from marked improvements in the economy and in other basic social services, all of which provide the much needed enabling environment. Ghana halved poverty rates between 1991 and 2013 (MDG Report 2013), improved food security, iodine nutrition, access to safe water, education, and employment.
However, there are regional disparities. In the three northern regions which have lower but very similar socio-economic contexts, there are marked intra-regional disparities in stunting rates as high as 32 percent in Northern Region, to 15 percent in Upper East Region (UER), and 23 percent in Upper West Region. Interestingly, while UER has the highest poverty rates, it has outperformed regions in the North and South. In my opinion, the disparities in stunting rates across the country reflect, to a large extent, the governance of available resources. If nutrition is given more attention at all levels, these disparities could be eliminated.
This sentiment was echoed at the recent launch of 2014 DHS findings by Ms. Esi Foriwa Amoaful, Deputy Director for Nutrition in theGhana Health Services Family Health Division: “We have made progress, but we need to do more, and we can change this.”
Lilian Selenje is a Nutrition Specialist working at UNICEF Ghana.