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.
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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.
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