GLOBAL HEALTH AND FOOD SECURITY: IMPERATIVES FOR THE FUTURE
Thursday, October 16, 2003
Speaker: Abenaa Akuamoa-Boateng

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Child Nutrition in Ghana
Dr. Abenaa Akuamoa-Boateng
Principal Nutrition Officer, Ghana Ministry of Health

            Good afternoon, ladies and gentlemen. Mr. Chairman, fellow speakers. I feel more than honored to be given this opportunity, which came about a day ago, to share with you a story about a little country, a little country on the West Coast of Africa. It’s quite a beautiful country, but there is a snake in the story in this country, and that snake is hunger and poverty.

            I wish to share with you some background information. As I said, it’s a very small country, population of about 19.5 million people. Our staple foods are mainly the roots and two cereals. And the two cereals that are of importance to us are maize, sorghum and millet. Our export commodities are all primarily agricultural commodities with very little value added, as you see on the board.

            We do have some precious minerals in the gold, because for those who know, the colonial name for Ghana was Gold Coast, and that was because when the colonial settlers got there, one of the very first things they saw were nuggets of gold on the beach of Ghana. And therefore as I said this is why Ghana has the name of Gold Coast, a coast on which you could actually pick nuggets of gold, has now about 45% of its population living on less than a dollar a day.

            However, one bright spot among the many bright spots in Ghana is that it is home to the Secretary of the United Nations, Kofi Annan.

            Talking about food security issues, they are the same as everywhere, just that there are a few differences that I would like to mention here. One of the major problems in Ghana is with our soils. I remember three years ago when I was in Iowa and I saw the very rich dark soils, all I said was, if we could have this soil in Ghana, I’m sure that that would be about the end of the hunger and poverty in my country.

            The other things have to do with high production costs. One of the things we see in Ghana, for those who have worked in the area of agriculture – I know some of you here have been there – has been the problem with the cost of materials and imports, such as fertilizer, seed and other such things.

            Another thing which goes against increased production in Ghana is simply that over 70% of the workforce on our farms are women, and a lot of the equipment that we use is actually inappropriate, coupled with the burden that the women have to bear in the household. High rates of..., something like 6.3 to something, as low as 2.3 when you get to the urban areas – they’re looking at the disease burden that affects these women and children, who are the main work force.

            And now that we have the problem of HIV/AIDS, one can see that we do really have a problem, the problem to do with production, more so when people are so poor. And there are no subsidies on things like fertilizer. There are no subsidies on seeds. There are no guaranteed prices for our crops. What happens is that the people who really matter to the perpetuation of the... generation, the women end up being the people who end up bearing the brunt of the hunger and poverty...

            I would like to look at just the nutritional issues affecting the vulnerable groups, the mothers and the children. There is a whole spectrum of health issues, but I would like to just stick to the mothers and children for the time that I have.

            The main nutritional problems that we find in our mothers and children are the protein malnutrition and micronutrient malnutrition, which is the sort of nutrition known as the silent malnutrition. And the main micronutrient deficiencies we have in Ghana are: iron deficiency anemia, iodine deficiency disorders, and the last but not the least is the vitamin E deficiency disorders.

            We would first like to look at the trend for protein malnutrition across the various districts of Ghana. And as one can see, as you go from the very urban, along the coast where we have our capital, Accra, to the Northern Savanna, you see that you will get a gradual increase. This story is an interesting story, but when you link it up with the agricultural production and food security issues in Ghana, you see the true reflection of hunger and poverty across the ten regions of Ghana.

            The other thing has to do with wasting, which is chronic malnutrition, looking at hunger of recent origin. And in the same way you see that, when you look at the end of the spectrum, you still find the Northern Region, and the Northern Region is the region that has the largest land area in Ghana but not the most densely populated. And there you have a lot of strife, you have a lot of degraded soils, and it’s not surprising that you always find it at the upper end of the scale.

            Last but not the least, I want us to look at stunting and stunting that measures chronic malnutrition. For us in Ghana stunting is very important, even though the nutritional and health of our population is normally measured by how many, the proportion of under-five children who are underweight. For us in Ghana we like to look at stunting, and this is simply because we know that stunting is not affected by a lot of the short-term or acute factors. Because we realize that the kind of hunger that we are facing is not hunger of a very short term thing. It is chronic hunger and is the chronic hunger that most people do not see. In fact, the pictures of the African children you normally see on your screens, those are the very acute cases, but for the bulk of the children in Africa and for the bulk of children in Ghana, it is this chronic malnutrition, the chronic hunger which is the main problem.

            And we know that when you look at stunting, we know that stunting affects people’s brain development, it affects the education, it affects the productivity in later life. And if Ghana has a vision to become a middle-income country by the year 2020, we wonder how we can make it if stunting levels are as high as 38% in the Northern Region. With the national average of about 25%, we wonder how we are going to make it. Because stunting actually reduces productivity, as we know. And it’s not surprising, as I said early on, that 45% of the population live on less than a dollar a day.

            In addition to that, we have problems with high maternal mortality rates in Ghana, we have maternal mortality rates within a range of something like 270 to almost 750 maternal deaths per 100,000 live births. And when you look at infant mortality, we have something in the range of something from as high as 140 to about 51.5 infant deaths per thousand live births. And this is unacceptable. We cannot see how we can move forward as a country if we have to grapple with things like this.

            We are all aware of the consequences of malnutrition, as I said. And one will ask – What is being done? Because something must be done – and something is being done. In the area of agriculture, there are a whole lot of schemes trying to increase and diversify local production. In the area of health and nutrition, there are a whole lot of other interventions aimed at improving maternal and child health as well as the nutrition of these groups.

            And I’d like to spend some time looking at what is happening in the area of the health and nutrition interventions. To be able to get the full story, to be interesting, to look at how it is being done, because the kind of interventions that we have are no different from so many other interventions that have been put in place in a lot of countries and for which, in most cases, have been found not to be very successful.

            But the interesting thing now in Ghana is that we now have a vision and a mission with a plan – what we call VMP – because we realize it is not enough to  have a vision, and it is not enough to have a mission. You must have a plan that will succeed. And this plan has actually been developed by a lot of political will and commitment.

            And to talk about this, what I’ll say is that until the last three, four years, there was a lot of talk about gender. There was a lot of talk about women and women being marginalized, women not having education, and therefore it’s impacting on productivity and on health of the Ghanaian population. But very little was done at the policy level to try to solve these things.

            But now there are some good things going on. And the first thing is that there is a policy shift. Now in health and the governmental business we have a whole cabinet position for the interest of women and children. There is a whole minister for women and children, and I tell you, she’s doing a good job.

            In addition to that, looking at the effects of female education on productivity and economic development of a country. In the Ministry of Education there is a minister whose sole responsibility is to look at female education.

            In addition to that, when you come into health, local governments have been asked to set aside 1% of their common fund. This common fund is a top priority to whatever budgetary allocations are given by the various ministries for the local governments to work in the particular areas that they have to do. But in addition to that, they have been asked to set aside 1% of their common fund to allocate to health issues, such as malaria, HIV/AIDS, and last but not least, malnutrition.

            In addition to that, the government has shown a lot of political commitment in that, if you look at the Ghana poverty reduction strategy, you will find these goals that I’m talking about in there in black and white. That is not the end of it, because we realize that it’s not all the things that go into the Ghana poverty reduction strategy actually end up being funded. But when you go into the strategu you also find that these goals and what it takes to get them done are also in there.

            And it’s also in the Ghana’s government five-year plan of work to make sure that these health issues that I’ve mentioned – malnutrition and the three micronutrients, iron, iodine and vitamin E – are taken care of in that program.

            Last but not least is the translation of political will into action. As I said, much as most governments will come out with slogans – things like the Green Revolution. In Ghana there was a Green Revolution (this is not the Indian one). And then Food for All, things like Zero Tolerance for Corruption.

            The interesting thing is that the Ghanaian government, for the first time in history – this is the first time, though, we’ve seen it being done – the present government within the first six months of this administration actually put its motto to work. And what it did was to jail one of our ministers for what most donors are afraid of and what most partners speak against – the issue of corruption. The minister, within six months of taking office, in the new government was jailed. It was recently that he was pardoned.

            In addition to that, for those of you who have worked in the area of agriculture and for those of you who are very familiar with Ghana, in the last administration the Ghanaian government wanted some people to invest in rice production, because we realized that in Ghana we had enough land and resources to actually cultivate enough rice for the country. Investors were asked to come and invest in Ghana.

            And there was a bad investment that was made, and what happened is that right now we have a previous agricultural minister, a previous finance minister and some of the chief directors – right now they have been sentenced, and are in jail. And they’re in jail not because maybe they squandered money or something, but that they made a bad deal.

            This tells you that the government is actually committed to making sure that whatever investments are brought in, or whatever money is put up for a particular project, actually goes towards the project. And this, I feel, has made most partners confident that, if they give Ghana what Ghana needs, Ghana can make a difference to the hunger problem.

            The various nutrition interventions are here, and the only things I like to say is just a little about the micronutrient supplementation and fortification program as well as the growth promotion program in Ghana.

            Now, talking about the micronutrient supplementation program:  The government has also shown a lot of political will and commitment. Ghana has been able to pass the law on iodinated salt – that is the fortification of all salt for human being and animal consumption in Ghana. And that was a big stride forward.

            There is another motion that has been sent to parliament, and I know that within the next few days that will also be passed. That is on the fortification of some staple foods with vitamin E and with iron.

            There is also another motion that has been passed and that deals with breastfeeding promotion and regulation. And this tells you the government is actually committed to meeting the goals that it has set in the area of nutrition health and its attendant things like hunger and poverty.

            The other thing I’d like us to look at is the dietary diversification program. And here Ghana realized that, despite all the effort that had been put in many years ago by the addition of, you know, people coming up with things like, “Oh, give the child a little egg, give the child a little milk, add some legumes,” and whatever. These things are not feasible in Ghana. They are not feasible because, for the poor farmers these leguminous crops are their security crops, and they will not use it to feed the child whom they think, and in our thinking, is not a productive member of the household during that period that he or she is a child.

            And, therefore, the only option that we realized was that we have to improve the staple, and there are a lot of improvements going on. The one important thing that has really worked for Ghana and was discussed during the 2000 World Food Prize, which was won by Dr. Villegas, was a quality protein maize. And now in Ghana the only seeds that are being produced for commercial cereal in the area of maize is cowpean seed.

            To wind up, what I’ll say – and this is the voice of the Ghanaian women and children, this is our voice – what we are saying is that hunger and malnutrition, the problem is being addressed, despite the many challenges and constraints. Progress is being achieved, albeit at a very slow and steady pace. We ask not for charity, nor sympathy. We only ask for realistic and efficient partnerships for the last lap.