Action - Improving nutrition of women and children: the MICAH program - Biofortification - Malaria cases|Pregnant women (PW)|Preschool-age children (Pre-SAC)

Programme: Improving nutrition of women and children: the MICAH program

Programme description

The MICronutrient and Health (MICAH) Program contributed to improved quality of life of women and children in five African nations (Ethiopia, Ghana, Malawi, Sénégal and Tanzania) over a 10-year period between 1996 and 2005. The problem of micronutrient deficiencies (vitamin A, iron and iodine) was addressed through integrated strategies and direct interventions that resulted in measurable positive effects. Quantitative and qualitative program results affirm the contribution of MICAH’s achievements towards the Millennium Development Goals, and global nutrition and health targets. 

Programme type



Ethiopia • $4.4 million budget (USD, 2002-2005)Ghana • $745,000 budget (USD, 2002-2005)Malawi • $3.8 million budget (USD, 2002-2005)



Start date:


End date:

Ethiopia, Ghana, Malawi
Target group: 
Malaria cases
Pregnant women (PW)
Preschool-age children (Pre-SAC)
Implementation details : 

Working in close cooperation with government, non-government organizations (NGOs), and communities, MICAH built on existing delivery systems within ministries of health, education and agriculture, equipping them to strengthen the coverage and quality of their mandated activities. The foundation for a self-sustaining nutrition and health infrastructure was laid, by empowering communities to take ownership for program activities within their grasp: exclusive breastfeeding, capacity building of community health workers in nutrition and health, establishment of household gardens and revolving funds, and latrine construction.

MICAH also provided education to local populations about the importance of health and nutrition. Thousands of community health workers and volunteers were trained while program staff were equipped with skills to monitor and evaluate the program, gathering valuable information to assess its impact.

Target population size : 
Ethiopia (1.8 million beneficiaries); Ghana (150,000 beneficiaries); Malawi (272,391 direct beneficiaries, with indirect benefit extending to 4.7 million people)
Coverage level (%): 
Outcome indicator(s): 


  • Prevalence of Clinical Vitamin A Deficiency among Children Under 5
  • Prevalence of Clinical Vitamin A Deficiency among Children 6-14 years
  • Coverage of Vitamin A Capsules among Children
  • Knowledge and Prevention of Vitamin A Deficiency among Women
  • Infections in Children 6-14 years
  • Immunization Coverage


  • Knowledge and Prevention of Vitamin A Deficiency among Women
  • Prevalence of Anemia
  • Knowledge and Prevention of Iodine Deficiency
  • Infections in Children
  • Infants Exclusively Breastfed for 6 Months
  • Infants Exclusively Breastfed for 6 Months


  • Infants Exclusively Breastfed for 6 Months
  • Anemia Prevention and Prevalence among Pregnant Women
  • Anemia Prevalence
  • Prevalence of Iodine Deficiency among School-Age Children
  • Prevalence of Malaria
  • Iodine Knowledge
  • Prevalence of Malaria
  • Iodine Knowledge
  • Water and Sanitation
M&E system: 


Supervision/monitoring visits were routinely made at all levels of Ethiopia’s MICAH projects.The program coordinating office and program partners conducted 86 visits to assess the implementation and progress of various initiatives.Throughout the year, activity reports and evaluation documents were reviewed, site visits made, and ongoing discussions held between MICAH staff and stakeholders. After every visit, copies of feedback reports were sent to the relevant ADPs and NGOs. At the project level, MICAH facilitators conducted joint field visits and reviews with frontline personnel such as government health workers, community health workers, volunteers and school teachers to ensure implementation of activities was proceeding according to plan.


Monitoring of MICAH Ghana improved in several ways in Phase 2 as the program team worked closely with Ghana Health Service and community health volunteers. Increased effectiveness was best illustrated by the heightened accuracy of data for iodized salt consumption after changing the method from school-based to houseto-house surveys.The team reinforced this effort by testing the quality of salt in markets as well. To improve monitoring of compliance with iron supplementation, MICAH facilitators worked closely with community health volunteers to assess whether women and children were taking the supplements as prescribed.Throughout the program, monitoring information was shared with all stakeholders at quarterly district and sub-district meetings in an effort to improve implementation and build ownership.


Regular meetings were conducted with government ministry and partner staff to share feedback and resolve issues.Training was provided and follow-up maintained to improve the capacity of field agents and staff. Regular community visits, including meetings with women and local leaders, provided management staff an opportunity to ensure quality implementation. Specific issues were dealt with using results-based management. For example, to obtain a more accurate estimate of deworming coverage in Phase 2, the household listing register was introduced and utilized, to supplement data regarding the de-wormed child. As a result of this new system, household monitoring revealed the extent of infection and enabled appropriate follow-up.To monitor the quality of the flour fortification project, the Malawi Bureau of Standards (MBS) and Chancellor College labs analyzed premix produced at the Domasi Fortification Unit. Each test found the Domasi premix to meet all MBS requirements; recommended levels of iron were found in the flour, and flour samples were free from contaminants.

Outcome reported by social determinants: 
Vulnerable groups


Revision log

Thu, 10/08/2015 - 11:35ginaContribEdited by engesveenk.published
Thu, 10/08/2015 - 11:35ginaContribEdited by engesveenk.published
Thu, 10/08/2015 - 11:35ginaContribEdited by william_nkoom.draft
Thu, 10/08/2015 - 11:35ginaContribAction edited by admin.draft