FANTA’s current work in Ghana focuses on community-based management of acute malnutrition (CMAM). USAID/Ghana asked FANTA to help strengthen activities to address acute malnutrition in children and to help the Ghana Health Service (GHS) improve technical capacity in nutrition. FANTA assists with the introduction and scale-up CMAM services, focusing specifically on severe acute malnutrition (SAM). FANTA also supports the integration of CMAM into the GHS, which helps improve access to CMAM services and strengthen service quality, health service provider competencies and the enabling environment for CMAM. The project’s previous work in Ghana included research on child care practices and child nutrition.
Integration of Nutrition Indicators into Ghana’s HIV and Tuberculosis Monitoring and Evaluation System: Since 2010, the GHS has been integrating nutrition assessment, counseling, and support (NACS) into routine HIV services. In December 2011, a rapid review of 11 NACS pilot sites in Ghana was conducted to assess strengths, challenges, and opportunities in these sites to inform the scale-up of NACS. One of the key recommendations of the rapid review was the need to integrate nutrition indicators into the routine HIV monitoring and evaluation system. The report, Integration of Nutrition Indicators into Ghana’s HIV and Tuberculosis Monitoring and Evaluation System: Summary Report, provides a summary of FANTA and Ghana Health Service activities that were taken to strengthen efforts in Ghana to integrate nutrition indicators into HIV and tuberculosis monitoring and evaluation systems for effective tracking of progress and decision making at the different levels of service delivery.
Nutrition Advocacy Briefs: FANTA and the GHS launched an initiative, “Build the Future, Invest in Nutrition Now,” to engage government and other high-level stakeholders in a collaborative nutrition advocacy process to identify, prioritize, and advocate for evidence-based actions to improve nutrition. As part of the launch, FANTA developed a set of nutrition advocacy briefs to guide discussions during a series of meetings with key stakeholders.
CMAM Inpatient Care Training Materials: In 1999, the World Health Organization (WHO) published the Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers and in 2002 the Training Course on the Management of Severe Malnutrition. FANTA, in collaboration with the Ghana Health Service and WHO/Ghana, adapted and built on the WHO documents and the 2010 Ghana Interim National Guidelines for Community-Based Management of Severe Acute Malnutrition to develop, Training Course on Inpatient Management of Severe Acute Malnutrition, a set of training materials for inpatient management of SAM intended to be used by health care providers working at the national, regional, district, and facility levels of the health system in Ghana.
CMAM Scale-Up: FANTA helped scale up CMAM activities in Agona District to provide coverage district-wide. FANTA further increased national CMAM capacity by conducting refresher training in Agona and Ashiedu Keteke districts for health care providers and community volunteers working in outpatient care facilities. Health care providers also received refresher training in the management of SAM with medical complications. The Severe Acute Malnutrition Support Unit (SAM SU) requested FANTA to conduct a review of CMAM activities at the learning sites, including plans for adding additional sites, and the results of the review, Report on the Review of the Integration of Community-Based Management of Acute Malnutrition into the Ghana Health System, August/September 2010, were published in 2011.
National Interim Guidelines for CMAM: Under the guidance of Ghana’s national-level technical coordinating committee for SAM and the SAM coordinator in the GHS, FANTA drafted the Interim National Guidelines for Community-Based Management of Severe Acute Malnutrition. Multiple partners, including program managers within the GHS and district-level implementers in Agona and Ashiedu Keteke districts, also contributed to the Interim Guidelines, which marked an important step toward harmonizing the management of SAM in Ghana.
CMAM Monitoring Tools and Data Repository: FANTA and the GHS SAM coordinator reviewed the CMAM monitoring tools – outpatient care treatment card, tally sheet and reporting forms – and trained health care providers in using them. The monitoring tools were adapted in line with international standards, which will help ensure quality of CMAM services. In addition, a data repository to collect CMAM monitoring information was developed based on these monitoring tools.
Ghana Nutrition and HIV Job Aids: Created in 2011, the Ghana HIV and Nutrition Job Aids assist clinicians and community health workers working in inpatient and outpatient HIV services to assess nutritional status and provide critical nutrition actions and information to people living with HIV. The job aids complement trainings in nutrition assessment, counseling, and support (NACS) in Ghana, and were developed through a collaborative process with the GHS nutrition department. Testing at initial pilot sites showed that the job aids were found to be useful not only by clinicians but also by counselors, expert clients, and others.
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