Outreach with GHS

At the first N4G Summit in 2013, 110 stakeholders committed to prevent at least 20 million children from being stunted – saving at least 1.7 million lives by 2020. These commitments deliver much-needed action on policy and financing commitments to the Sustainable Development Goal (SDG) 2—Ending Hunger in All its Forms—which is an underlying driver of 12 of the 17 SDGs. As we continue the Nutrition for Growth Year of Action, take a look at how pledges made during the N4G summits in London (2013) and Milan (2017), have brought about positive impacts on global nutrition.

According to the latest Ghana Demographic and Health Survey (2014), nearly 1 in 5 children under age 5 is stunted. The Ghana Nutrition Improvement Project (GNIP) aims to solve the problem of stunting during the weaning period (from 6 months to 2 years of age), which is caused mainly due to the insufficient content of essential nutrients in the traditional complementary food “koko” (fermented corn porridge). The mission of GNIP is to create a “Social Business Model” for improving child nutrition in a sustainable way without continuous aid. The Ajinomoto Foundation (TAF), a public interest foundation, acquired GNIP in 2017, after its launch in 2009 by Ajinomoto Co. Inc.,1 a global food and amino acid company. TAF is not involved in business but supports local partners to establish sustainable business. 
TAF has been working to improve the nutritional status of infants in Ghana through the introduction of a complementary food supplement named “KOKO Plus.” KOKO Plus is produced locally using locally available ingredients (soybean) supplemented with micronutrients and lysine to improve the amino acid balance. KOKO Plus is an evidence-based product (World Food Programme [WFP] registers KOKO Plus as a “Nutritious powder” in its food basket) and is designed to meet local needs: it is affordable (USD 0.10 /sachet /day); acceptable (for local tradition and preferences); and accessible (available in kiosks near health facilities and with a one-year shelf life). 
A sustainable social business model should be scalable and inclusive, meaning that all processes from product development, production, and distribution would be primarily carried out by local people. GNIP officially collaborated with Ghana Health Service (GHS) (concluding Memorandum of Cooperation in 2018) to co-create nutrition education tools and design a behavior-change process that applies the private sectors’ marketing intelligence. The process centers on a cycle of Awareness, Understanding, and Action. Health workers monitor and record children’s nutritional status (Awareness), and then they use simple pictures to educate mothers about basic nutrition knowledge and introduce KOKO Plus as a practical solution to improve child nutrition (Understanding). Once mothers understand the importance of nutrition and how to improve it, they get interested in KOKO Plus, and they purchase it from shops at the nearest health facility (Action).2 Mothers continue to use KOKO Plus once they see their children’s improved growth, and they become more confident. This cycle (Awareness, Understanding and Action) continues monthly and reinforces the mother’s behavior change.
Collaboration with GHS started in 2018, and in 2019, an estimated 47,000 beneficiaries (children fed KOKO Plus) and 3,000 nurses participated in the collaboration. The number of beneficiaries is expected to increase to 450,000 children by 2023. The growth in the number of beneficiaries has been significantly accelerated. The following factors contributed to this success:
For the successful duplication or scaling up of the public-private partnership (PPP) model, it is important to establish a memorandum of understanding/cooperation at the national level; additionally, to execute the collaborative activities, it is also essential to have mutual communication on the ground at the regional and district levels. By openly sharing challenges/problems and understanding the competencies/assets of each party, we could work together successfully and produce genuinely synergistic impacts. 
We believe our efforts with KOKO Plus will contribute to strengthening the nutrition services of GHS’s health facilities, and after scaling up in Ghana, will eventually contribute to establishing Universal Health Coverage by duplicating this PPP model in other countries, which is an ultimate goal of Sustainable Development Goal 3.