Action - Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative - Management of severe acute malnutrition - Infants and young children|SAM child

Programme: Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative

Programme description

Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.

Over the next five years in Ghana, Feed the Future aims to help an estimated 860,000 vulnerable Ghanaian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 324,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.

To meet its objectives, Feed the Future Ghana is making core investments in three key areas: 

1. To achieve food security, agriculture programs will focus on driving a step-change in the volume and value performance of core staple value chains—starting with rice, maize and soy—and improving the governance of marine fisheries resources.

  • Improving the Enabling Environment for Private Sector Investment
  • High Impact Value Chain Activities and Investment

2. To help reduce malnutrition and improve household resilience of vulnerable populations, agriculture and nutrition programs will focus on a) improving access to diverse quality food, b) improving nutrition-related behaviors within vulnerable households, c) developing community mechanisms to identify and address their food and nutrition problems, and d) strengthening coordination of government and other actors to meet food security and nutrition objectives.

3. To improve the nutritional status of women and children, nutrition programs will focus on:

  • Improving nutrition-related behaviors and community norms regarding nutrition
  • Expanding community-based treatment of acute malnutrition of children
  • Expanding the accessibility of safe, quality foods available for child weaning in Ghana
  • Identifying and addressing the root causes of severe levels of anemia among women and children in Ghana

In addition to these three core areas, environment, natural resource management, climate change, and gender are incorporated as cross-cutting issues in all programs and activities as guiding principles.

Target Regions

A strategic focus on the rice, maize and soy value chains for five years could raise tens of thousands of people out of poverty, 75 percent of whom would be in northern Ghana. Improving marine fisheries governance in the Western Region will benefit fishery households and increase the nutritional status of fish consumers across Ghana. 


Northern Zone. The rural northern regions have the highest rates of food insecurity in the country—as much as seven times the national average. The northern zone program will aim to improve economic opportunities and diversify household income by doing the following:

  • Identifying and facilitating private investment into the agriculture sector in order to strengthen rice, maize and soy value chains to produce more and better staple food products
  • Leveraging technical knowledge and seeking innovations, especially in the areas of science and technology
  • Increasing income during lean periods
  • Encouraging the production of nutritious foods for household consumption and income generation
  • Supporting communities to develop plans for storage, food safety and food security
  • Improving nutrition-related behaviors

Coastal Marine Fisheries Zone. Poverty in the coastal areas of Ghana is extensive, with the average welfare level among food farmers in rural coastal areas 12 percent below that in large urban centers such as Accra. Marine capture fisheries are the major economic activity along the coast and their importance reaches far beyond the coast. There is strong evidence that Ghana’s coastal ecosystems are already seriously degraded and experiencing erosion and  will undoubtedly be under growing pressure with an oil and gas industry on its way. The Feed the Future program will: 

  • Support direct, targeted interventions where the poor fisheries-dependent households are located and focus on what has greatest potential for improving their situation, as well as the environment
  • Increase the ability of coastal residents to better access and manage their most important productive asset: marine fisheries

National Scale Nutritional Programming. In coordination with other development partners, Feed the Future will support the Government of Ghana’s implementation of a comprehensive program of community-based management of acute malnutrition through a comprehensive behavior change program. This comprehensive package will improve nutrition-related behaviors and will be incorporated into programming in the Western, Central, and Greater Accra regions. Operational research will be conducted in 2011–2012 to better understand the extremely high rates of anemia among children in Ghana. This research will be used to develop key nutritional aspects of Feed the Future programming and to shape a national child anemia strategy and program that can be undertaken by Ghana Health Service and its development partners.

Programme type



60 million US dollars



Start date:


End date:

Northern region of Ghana
Target group: 
Infants and young children
SAM child
Implementation details : 

Efforts to decrease poverty and improve options for food consumption will not have a significant impact upon the nutritional status of most Ghanaians unless they are accompanied by strong household and community understanding and motivation to change child feeding behaviors, and improvements in nutrition services and products that are offered to the public. For this reason, FTF in Ghana will invest resources through USAID/Ghana’s health program to prevent and treat undernutrition.

Improved nutrition-related behaviors and community norms regarding nutrition
USAID/Ghana is helping to expand and improve behavior change approaches related to nutrition and to develop training materials and approaches for infant and young children feeding and dietary diversity. In FY2011 a national Infant and Young Child Feeding (IYCF) campaign will be launched using mass media, a range of educational and community action materials, and community-led efforts and interpersonal communication by health staff and community volunteers. This campaign is expected to contribute significantly to improved feeding practices and increase the prevalence of minimum acceptable diet among children 6–23 months. USAID’s Behavior Change Support Program (BCS) will design the national campaign with the active involvement of the GHS, coordinating outreach activities with JICA (Japan International Cooperation Agency), UNICEF, and the World Bank, all of which are active in nutrition promotion in the northern regions. This will ensure that messages heard across the country are uniform and consistent. This national campaign will target all adults who care for children less than five years of age throughout the country. Heads of extended families and household decision makers (most often men) will be a particular target group for this campaign, to improve allocation of household resources towards child nutrition. USAID will support all outreach components of this intervention in the regions currently targeted by USAID’s overall health program (Greater Accra, Central, and Western), and in the northern regions targeted by the Feed the Future program, while the other areas of the country will receive the same package of outreach materials delivered through other actors (GHS with support from UNICEF, JICA, World Bank, etc.)

Key messages and related activities will promote the following behaviors: Exclusive breastfeeding through the first six months of life; Complementary feeding as of six months of age; Dietary diversity Maternal nutrition Care of sick children; Utilization of maternal, child health and nutrition services; Household water treatment Hand washing with soap Safe sanitation practices.

Expanded community-based treatment of acute malnutrition of children
Since 2008, USAID/Ghana has supported a community-based program to treat acute undernutrition (CMAM). Through the FANTA-2 project (Food and Nutrition Technical Assistance), USAID provides technical assistance to the Ghana Health Service (GHS) to integrate CMAM services into the district health system. A Severe Acute Malnutrition (SAM) Support Unit was established at the Nutrition Department of the GHS to provide technical support for CMAM implementation and coordination of CMAM activities in the country. From an initial pilot in two districts, the GHS plans to scale up the CMAM program nationally; USAID is already beginning this effort with support from UNICEF in the Northern Region. The CMAM platform also provides opportunities for improving the skills of health care providers, community outreach workers, mother support groups, and community health workers to provide quality nutrition services for mothers and children under two years of age.

To increase the reach and sustainability of the program to combat malnutrition in children, USAID is building private sector capacity for local production of ready-to-use food to be used in treatment of severely malnourished children. Local production is expected to start in FY 2011.

Expanded accessibility of safe quality foods available for child weaning in Ghana
The normal weaning foods used in Ghana are thin gruels based on cassava or other starches, which provide carbohydrates and assuage hunger but are otherwise quite poor in nutrition. In order to facilitate the adoption of improved weaning practices and increase the nutritional content of the diets of young children, USAID is exploring strategic partnerships to promote nutritional products that have a critical set of attributes including: a) would fill specific nutritional gaps in the existing diet of pregnant women and/or young children; b) can be marketed at a low enough price point to be feasibly accessible by the lower income segments of the population; c) has a reasonable chance of becoming sustainable over the medium term; and d) has significant existing support including investment from other private sector, government or civil society agencies.

A variety of actors, including private sector companies, Ghanaian universities, and non-governmental groups, have approached USAID with potential products and strategies in this regard. USAID will continue to track the progress of the different initiatives already underway, including several that already have support from other USAID programs such as CRSPs (Collaborative Research Support Program), and will determine whether any of them are likely to meet the four criteria listed above.
A critical related issue is access to clean and safe drinking water and sanitation facilities, which greatly impact the health of women and children and will be assessed and considered in the context of this intervention.

Causes of severe levels of anemia among children in Ghana identified and addressed
The levels of maternal and children anemia in Ghana, 59 percent and 78 percent respectively, actually increased between 2003 and 2008 according to the 2008 Ghana Demographic and Health Survey, even though other health indicators improved over the same period.

Maternal anemia is a major factor in both maternal and infant health in Ghana, which are the focus of USAID’s current maternal and child health program. To address the problem of maternal anemia, USAID/Ghana is providing support and technical assistance for quality prenatal services, coordinated with malaria prevention and deworming activities. USAID’s ongoing programs to improve the quality of maternal health services will include a sharper focus on maternal anemia prevention and treatment during the prenatal period.

Unlike maternal anemia, there is not a sufficient evidence base nor are there extensive programmatic experiences to inform child anemia programs. The causes of anemia in young children are multi-faceted, and while closely linked to maternal health and nutrition, cannot be explained by poor maternal nutrition alone. Many factors including dietary insufficiency during weaning, repeated bouts of malaria, diarrhea and other diseases, intestinal parasites, and even high prevalence of the sickling trait have been posited to explain the extraordinary levels of child anemia in Ghana. Some of these factors are being addressed through other programs, such as the expansion of malaria prevention programs and school-based deworming interventions. However there is a compelling need to obtain current information on the relative importance of contributing factors, service delivery challenges, and barriers to reducing prevalence of anemia in young children. USAID will consider supporting Ghanaian public health and nutrition research institutions to perform operations research that will include problem identification and the development and application of improved tools, technologies, and approaches for addressing child anemia. Approaches identified as being the most promising will be field tested by existing USAID health activities to determine their potential to be scaled up to a national level. This activity will be performed in collaboration with other established and recognized institutions to contribute to local capacity strengthening and sustainability.

Target population size : 
Reaching nearly 324,000 children, improving their nutrition to prevent stunting and child mortality.
Coverage level (%): 
About 75 percent of Ghanaians assisted would be in northern Ghana
Outcome indicator(s): 

Improved nutrition related behaviors

  • Prevalence of exclusive breast feeding of children under six months
  • Percent of children 6-23 months that received a Minimum Acceptable Diet, disaggregated by sex

Improved utilization of maternal and child health and nutrition services

  • Prevalence of maternal anemia
  • Prevalence of child anemia
  • Percent of children who are wasted
M&E system: 

 USAID/Ghana will continue using the basic methodology of its existing Performance Monitoring Plan (PMP) for 2009–2013 that includes its monitoring of regular Development Assistance funds, GFSR, and FTF funds. With technical support to be provided by USAID/Washington, USAID/Ghana will build on its current monitoring and evaluation (M&E) systems to design and establish a comprehensive new FTF M&E system and PMP in 2011. In addition, the Mission has several years of experience using the Initiative to End Hunger in Africa (IEHA) monitoring and reporting system which will form the foundation for FTF monitoring and reporting. Since Mission implementing partners will be the source of a great deal of information, their own monitoring and reporting systems will be set up to provide the appropriate sex-disaggregated data, results, indicators, followed by regular monthly, quarterly, semi-annual, and annual reports to comply with the Operating Unit’s overall M&E system requirements. The Mission will be more watchful in ensuring that sex-disaggregated data is collected at all levels of indicators (outputs, outcomes and impacts), and will use available resources to invest in more in-depth analysis of the impacts of programs on men and women.

Data Quality and Management: FTF M&E will benefit greatly from assistance provided by the USAID’s GSSP project to strengthen Ghana’s agricultural statistics system. A new system is being launched in 2011 called the Ghana Agricultural Production Survey (GAPS). The key improvements to be made in the current Multi-Round Crop and Livestock Survey (MRCLS) are a disaggregated and updated sample design (district representativeness), expanded scope and depth of (geo-referenced) agricultural information collected, and new and enhanced management system consisting of improved data management practices and tailored software for improved and timely data processing, monitoring, and reporting. This resource will provide unprecedented household (gender disaggregated) information on an annual basis to help report on a number of FTF indicators.

Other than the in-house sources of information, various other M&E analytical tools, structures, and approaches will be considered for establishing baselines and constant monitoring. These options include instruments like the Ghana Living Standards Survey (GLSS- the local version of the LSMS), Participatory Poverty and Vulnerability Assessment (PPVA), Poverty and Social Impact Analysis (PSIA), and the Northern Ghana Food Security and Nutrition Monitoring System.
Data from the Demographic and Health Survey, which was last conducted in Ghana 2008, provides the baseline for nutrition and maternal and child health interventions. The USG will support this survey again in 2011, and therefore will have access to important data to assess the impact of the program at its midpoint. The Multiple Indicator Cluster Survey, conducted by UNICEF with support from USAID and planned for 2011 and 2015, will provide impact data to assess the success of the FTF program in Ghana at the conclusion of this Strategy period.

Developing National/Regional Capacity to use Data: IFPRI (through the GSSP project) is helping to establish the CAADP Strategic Analysis and Knowledge Support System (SAKSS) Node and will continue to provide the professional guidance to the country to ensure high quality statistical data remains available.

In addition, a Technical Services staffer will support the ASWG Secretariat in carrying out its functions effectively, including tasks like helping stakeholders (especially MOFA) keep track of agricultural related public and private sector investments and foreign support to the sector. There may be times where additional design work will be needed to create results monitoring frameworks for new activities and assist in modifying existing frameworks by adjusting indicators, defining baselines and setting targets. In addition, the Mission will be a partner in Joint Sector Reviews of agricultural sector performance conducted jointly by MOFA and development partners according to a mutual agreement the Mission supports for transparency, accountability, benchmarking, and results monitoring.

Impact Evaluations: The USG will ensure that evaluations for FTF will be adequately covered by above mentioned Technical Services PASA. One of its primary objectives is to evaluate and assess impact of the USAID/Ghana/EG portfolio of investments, in relationship to GOG and donor portfolios, and in relationship to Ghanaian needs in order to make progress towards MDGs and sustaining status of a middle income country. This includes providing relevant information for design of new and/or scaled-up projects as USG increases its investments in Ghana.

Evaluations will include both qualitative and quantitative methods. The hypothesis is that the development process itself can have a significant impact on and bring change to the Ghanaian environment. The objective is to test how much influence FTF programs have had on human behavior, human attitudes (e.g., trust in value chain systems), business and commercial practices, establishment of value chain linkages, increased livelihood options, smoothed out income flow over time (not just level of income), institutional efficiency and quality service delivery, and the programs’ impact on reducing key gender disparities. In addition, the programs should be evaluated to see if they were effective enough to bring about a transformative change or improvement in the lives of the poor, mainly in the northern regions.




Lead indicators will include: prevalence of women with anemia; prevalence of childhood anemia; prevalence of diarrheal diseases, diet diversity among children under five; percent of children who are wasted.

Lead indicators will include: prevalence of women with anemia; prevalence of childhood anemia; prevalence of diarrheal diseases, diet diversity among children under five; percent of children who are wasted.

Outcome reported by social determinants: 
Vulnerable groups
Socio-economic status

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