Hunger-Undernutrition Blog

Getting the 'NACS' of Nutrition in HIV and TB Care in Ghana

Guest blog post by Catherine Adu-Asare and Simon Sadler, with FHI360/FANTA

Diseases such as HIV and TB have a devastating impact on the nutritional status of individuals as well as their families and communities. The nutrition assessment, counseling and support (NACS) approach aims to improve the nutritional status of individuals and populations by integrating nutrition into policies, programs, and health delivery systems. These interventions address many of the issues that contribute to malnutrition in people with these diseases. A growing number of governments are adopting the NACS approach to improve the health of their populations as well as to strengthen the delivery of health care services.

Ghana is making coordinated efforts to integrate the NACS approach at policy, program and implementation levels. In 2006, the Ghana Ministry of Health (MOH) and the Ghana Health Service (GHS) launched national guidelines on Nutritional Care and Support of People Living with HIV/AIDS (PLHIV), as the first step in integrating NACS into HIV services. In 2010/2011 the GHS piloted the NACS approach among eleven HIV care and treatment centers. Based on results of that pilot, the GHS has planned to scale up the rollout of NACS to an additional twenty-nine facilities; covering more than 200 clinicians and care providers. 

One component of the strategic roll-out of the NACS approach was training of regional-level GHS staff and trainers in NACS in Kumasi District, 250 km north of Accra, in August 2012. The training brought together 26 participants including the Regional Nutrition Officer, Regional HIV coordinator, Regional TB Coordinator and Regional PMTCT Trainers from Ashanti, Brong-Ahafo, Northern, Upper East, Upper West, Volta and Western Regions. Each of the participants formed into region-based multidisciplinary teams who would go on to plan and implement subsequent training sessions for facilities and care providers in their respective regions.

The training covered myriad topics, from basic nutrition and nutrition assessment to the management of malnutrition for people with HIV and TB. Participants had an opportunity not only to become familiar with the training material but also strengthen their capacities as trainers. By the end of the training, the regional teams had developed plans targeting up to four facilities in each region. Regional trainings will be supported by the national level team of facilitators within the GHS and other partners to provide ongoing mentoring and supervision to ensure services are implemented effectively.

Through the implementation of the joint NACS training, two critical factors were identified that provide valuable lessons for other countries planning to scale up the NACS approach. The first of these factors is the importance of cooperation and collaboration between government departments in planning and implementation of activities. This not only ensures consistency across the health system but also provides an opportunity to integrate elements of the NACS approach across a broader range of services. Secondly, identifying strong leadership within the Government to 'champion' the rollout of the NACS approach is absolutely critical in ensuring the activities are owned within the health system and services. Combining these two elements with strong, strategic partnerships with organizations that utilize technical skills and implementation experience, lay the foundation for building the NACS approach across the entire health system.

Trainers and participants at the ‘NACS Facilitators Workshop’ in Kumasi, Ghana July 31 – August 4, 2012

The NACS approach is supported by a collaborative of Government of Ghana agencies including the National AIDS Control Program (NACP), the Ghana AIDS Commission (GAC) and the Ghana Health Service (GHS) Nutrition Division. The training engaged other partners in Ghana including the World Food Programme (WFP) and the DELIVER project. Funding was provided by USAID/Ghana and PEPFAR/Ghana.

The Olympic Hunger Summit

On the last day of the Olympics, UK Prime Minister David Cameron and Brazilian Vice President Michel Temer hosted the Olympic Hunger Summit, an event designed to draw attention to the issue of hunger and malnutrition around the world.  The event was attended by government officials from several nations, private sector leaders, and Olympic athletes, including Brazilian soccer legend Pelé and Mo Farah, a Somali-born British double gold medalist who started a foundation to support development in East Africa.  Prior to the event, several British Olympic athletes wrote a letter to Prime Minister Cameron urging him to "fire the starting gun on the biggest ever push against hunger and malnutrition."

 

At the Summit, Prime Minister Cameron and Vice President Temer called on world leaders to make a commitment to save 25 million children from malnutrition and stunting between the 2012 London Olympic Games and the 2016 Games in Rio de Janeiro. 

Both the UK and Brazil are current leaders in food security and nutrition. The UK has been a vocal advocate and supporter of development programs and Brazil has experienced tremendous success in fighting hunger through Fome Zero, for which former President da Silva was awarded the 2011 World Food Prize.  

According to DFID, three government and private sector initiatives were announced at the Summit:

• The UK government committed to support CGIAR to create drought resistance and vitamin enriched crops to help feed 45 million people a year in Asia and Africa.  Alongside Canada, Ireland, the US and the Gates Foundation, the UK will also invest in HarvestPlus to roll out nutrition rich seeds and tubers to benefit 3 million people in Africa and India.
• UK companies like Unilever, Syngenta and GSK will work to find ways to make nutritious food available to poor families at prices they can afford.
• The UK government will work with partners like Ireland and Switzerland to improve government accountability in developing countries and to pilot text messaging as a way to provide early warnings of areas where nutrition supplies are needed.

While the Olympic Hunger Summit did succeed in shining a spotlight on the huge problem of malnutrition and hunger around the world, it remains to be seen if the UK, Brazil and other global leaders can keep the world's attention over the next four years.  In the words of the British athletes: "The eyes of the world are on London 2012. The best legacy the Games can leave is a world where strong, healthy and well-nourished children can achieve their full potential in life."

Video Credit: International Business Times via YouTube

 

IFPRI policy briefs offer lessons for scaling up development successes

Guest post by the International Food Policy Research Institute

The attention of donors and governments throughout the world is focused more than ever on battling poverty and hunger through investments and aid to agriculture, rural development, and nutrition.

Yet many of these development interventions are limited and short-lived. Incoming political leaders tend to promote their own new initiatives, and bureaucracies are plagued by a lack of continuity in leadership, a focus on the new and different, and a lack of effective evaluation of what works and what doesn’t. The number of aid-supported projects is rising, while their average size continues to shrink.

To ensure value for money and make essential development gains, successful projects must be scaled up; that is, expanded, replicated, and adapted to reach a greater number of people.

“Scaling Up in Agriculture, Rural Development, and Nutrition,” recently released by the International Food Policy Research Institute’s 2020 Vision Initiative, is a compilation of 20 policy briefs that describe experiences and share lessons on taking development interventions up to scale. Edited by the Brookings Institution’s Johannes Linn, the briefs are written by a wide range of actors, from local community representatives and NGOs to private businesses and donors.

The briefs show that there are no blueprints for when and how to take an intervention to scale. However, successfully scaled up projects—whether they expanded horizontally to other geographical areas, functionally to additional programming, or vertically to the national level—tended to follow key principles, use drivers to push the process forward, and seek out or create enabling spaces in which their initiatives could grow.

These projects most commonly started with an idea or model that worked at a small scale or had been promoted successfully elsewhere; had visionary leaders and or champions who recognized that scaling up was necessary, desirable, and feasible; were pushed forward by catalysts such as political or economic crises or pressure from outside actors; and offered incentives and accountability for results.

The enabling spaces they found or created included effective institutions, policy and regulatory frameworks, fiscal and financial resources, advocacy and outreach to key political actors, mobilizing partnerships, and learning through analysis, monitoring, and evaluation.

The stories range from experiences of scaling up local community development in the Peruvian highlands and regreening the Sahel to the Scaling Up Nutrition movement and projects from the Bill and Melinda Gates Foundation, PepsiCo, and Oxfam, as well as innovations such as biofortified sweet potatoes and many other topics.

It is hoped that these briefs will help donors, governments, and development practitioners bring to scale interventions that can make real progress towards improving agricult
ural productivity, rural incomes, and nutrition, and achieving the Millennium Development Goals.

This post is excerpted from “Overview: Pathways, Drivers, and Spaces” and “Lessons on Scaling Up: Opportunities and Challenges for the Future” by Johannes F. Linn in IFPRI's 2020 Focus 19 publication, Scaling Up in Agriculture, Rural Development, and Nutrition.

Photo credit: ©IFAD/Susan Beccio