By Scott Bleggi
How do you communicate important messages on nutrition, health, and child care among women who have little formal education and can’t read or write? Bread senior policy analyst Scott Bleggi accompanied staff from World Vision to a rural village west of Ghana’s capital, Accra.
In Ghana, there have been remarkable gains in improving the nutrition of mothers and children, but persistent problems of anemia (lack of iron) remain. More than half of all women are anemic, as are 75 percent of children younger than 5. Donor organizations in Ghana, including World Vision, have a long history of outreach programs designed to educate expectant and new mothers about how improved nutrition can make pregnancy safer and healthier and help their children get off to the best possible start in life.
In cooperation with the Ministry of Health’s Ghana Health Service, World Vision designed an innovative Behavior Change Communication (BCC) education program. It has been successful because it uses traditional communication means at both the village and district levels. Mothers themselves have proven to be very effective messengers. Mother-to-Mother support groups—such as the one Bleggi visited at a health center shared by two villages — can educate and, at the same time, help create new nutrition advocates in villages.
Ghanaians use song as a way of communicating socio-cultural history and as an educational strategy. Once a song is learned and sung a few times, people can convey and reinforce the information in the song’s verses simply by singing the song again or teaching it to others. Ghana Health Service works with traditional birth attendants in villages—who are usually highly-respected older women, often grandmothers—and with community volunteers, who may be fathers or other family members. World Vision trains Community-based Surveillance Volunteers who both educate others in their communities and report key health-related data to a district-level coordinator. With widespread use of cell phones, the volunteers can quickly report in and receive further training. They work throughout rural communities, encouraging prenatal health care and helping with important postnatal practices such as exclusive breastfeeding and proper nutrition for both moms and babies.
In Saltpong-Biriwa, located along the coast 150 kilometers from Accra, an active group of more than 60 mothers who have newborn babies or children under 2 meets regularly at the community health center. These well-attended gatherings offer an opportunity to socialize, exchange ideas, and learn about health, nutrition, and health care. During Bleggi’s visit, the group sang “the breastfeeding song” for him. The Behavior Change Communication messages—aka the verses of the song—are: practice exclusive breastfeeding (no other food or drink) for 6 months; begin breastfeeding within 30 minutes of the birth; breastfeed because it provides all the nutrition a baby needs; and give babies the best start in life by breastfeeding.
Nutrition improvements are a key part of the U.S. government’s Feed the Future and Global Health initiatives. The Scaling Up Nutrition or SUN movement and the 1,000 Days Partnership encourage national governments and civil society organizations to ramp up nutrition programs — with an emphasis on maternal/child nutrition from pregnancy through the child’s second birthday. In Ghana, there is a well-coordinated effort that includes support from the U.S. government (through the U.S. Agency for International Development, USAID) and other donor governments; leadership and support from the Ghanaian government; educational and other programs planned and implemented by civil society organizations around the country; and local communications and data collection from a network of grassroots volunteers. The result is a remarkable improvement in nutrition and women’s health.
World Vision has been working in Ghana since 1979 on food security and nutrition programs. Past projects have had significant results — for example, World Vision’s Micronutrient and Health (MICAH) project, which ran from 1997 to 2005, reduced wasting (a child too thin for her height) in children under 5 by 13 percent, stunting (a child too short for his age) by 4 percent, underweight (children who weigh too little for their age) by 11 percent, and anemia by 44 percent from baseline measures.
Following Ghana’s example — with government leadership, communication and collaboration at all levels of program implementation, and volunteers who reinforce and sustain nutrition and health messaging — could put many more countries on track to meet Millennium Development Goal 1, to radically reduce hunger and malnutrition.
Scott Bleggi is a former policy analyst at Bread for the World Institute.