Given the opportunity, communities can improve on their lives: The Ghana Experience
It was a bright sunny day and I joined other Community nutrition project team members to undertake a two hour journey to Komenda/ Edina/Eguafo/Abirim district of the Central region of Ghana to participate in a review meeting involving ten communities. As we got closer to our destination, we observed school children chattering excitedly and following our four wheel drive vehicle and it was obvious that not too many of these types of vehicles visit such communities often. The excitement reached its climax when we arrived at the venue where we observed the district level policy makers including the District Chief Executive, the Presiding member of the District Assembly as well as traditional rulers clad in their rich Ghanaian attire and ornaments (normally reserved for visiting dignitaries) and accompanied by community members had gathered in the village square.
As typical of Ghanaian communities, women's groups had composed various songs and were supported with drumming by the men in the community. We were all drawn into an exciting traditional dance and realized that the words of the songs were messages on child care activities featuring the importance of breastfeeding, complementary feeding, family planning, and of monitoring child growth. After all the welcome pleasantries, the event for the day started.
Komenda/ Edina/Eguafo/Abirim district is one of four districts out of the total of one hundred and thirty in the country selected to benefit from a Community Based Nutrition and Food Security Project which formed part of a Community Poverty Reduction Strategy of the Government of Ghana and supported with funding from the World Bank. The project was designed to increase the awareness of the communities about the effects malnutrition and its control through improving their household food security, strengthening their capacity to identify and take appropriate action to address the determinants of malnutrition, improving child care-giving practices especially quality and quantity of food intake of children at home and through these activities eventually reducing the incidence of underweight among children under five. Prior to the start of the project activities, the regional and district personnel had undergone preparatory activities involving advocacy and consensus building among agriculture, health and other stakeholders which enabled them develop common strategies to link nutrition and agriculture. This was followed by the selection of community volunteers by the community leaders, training of the volunteers on community growth promotion activities and essential nutrition actions, selection of twenty households in each community for training in agriculture activities covering pineapple and vegetable gardening, fruit tree planting in the communities, small ruminants/snail rearing, poultry keeping, and mushroom cultivation. In addition, women groups had the opportunity to access credit to either start or expand on their economic activities.
The volunteers organized monthly Growth Promotion sessions-under the supervision of sub-district health staff-for children under five during which other associated health activities based on Essential Nutrition Actions (including breast feeding, complementary feeding, Vitamin A supplementation, use of iodized salt, family planning, immunization and use of insecticide treated bednets) were emphasized
The volunteers also conducted follow-up visits to the homes of children who do not show adequate improvement in growth. With the support of the sub-district health staff, meetings are held after each monthly session with the Community Implementation Committees during which the performance of the participating children are shared. The leaders then discuss and agree to some of the support activities they would undertake to contribute to improvement of the growth of the children.
Agriculture extension officers also gave technical support for community and backyard gardens. In addition, women had the opportunity to access credit to either start or expand on their economic activities.
The climax of the day's activities was the presentation of the achievements of the participating communities. Following two years of implementation of the project activities, 1803 children aged two to five years, had been registered in the ten communities out of which 66-81% of them attended Growth Promotion sessions regularly; 85-100% of caregivers were practicing exclusive breastfeeding; all children that participate in the growth monitoring sessions were fully immunized at the prescribed ages; fever and diarrhea had reduced remarkably and various agricultural activities were flourishing in the communities.
In addition, 391 caregivers in the ten communities had accessed loans of between 300,000-500,000 Cedis (US$33-US$55) for income generation activities.
As a result of all these activities, underweight had reduced from 26% at baseline to 15% in the zero to two year group and from 47.2-36% in the two to five year age group.
The traditional touch was very prominent in the meeting with drumming and dancing to celebrate the achievements of the communities. As motivation to the hard working communities and volunteers the district assembly gave rewards to the best performing community, the best growth promotion volunteer and the household with the best backyard garden. Even though a challenge such as access to potable water is still to be resolved, there was satisfaction among the communities that they had helped to improve the condition of children in their communities. The project has indicated that given the opportunity and necessary support, communities are able safeguard the nutritional status of their children.
This was adequately summed up by a supervisor of the project in the following words:
"Classroom knowledge alone is not sufficient for the effective and efficient performance of the Growth Promoters and Community Implementation Committees. Most of the Growth Promoters who were selected with little or no educational background are performing very well. They exhibit high levels of commitment and dedication to the work they do. They have learnt very fast and very well. Roles and responsibilities have been assigned in such a way that those who cannot read and write very well do the weighing and counseling and the others do the recording...
As we left the meeting with more traditional music and dancing in the background, and drove past many communities that have not had the opportunity to benefit from such projects, we could not help but recall some of the comments passed by the review participants (quoted below) and wondered how long it would take to expand such community based programmes to improve the lot of many other communities in similar need."
- "Now we don't have to walk long distances — sometimes in the sun and rain — anymore to attend child welfare clinic. Thanks to the project."
- "The children are not visiting the clinic because they do not fall sick now"
- "We feel more free at sessions because the growth promoters are our own brothers and sisters"
- "I saw the growth promoters at work and I loved it"