Evaluating the Implementation of Child Nutritional Policies: A Case Study of the Community-Based Management of Acute Malnutrition (CMAM) in Ghana

Abstract

Abstract Malnutrition is a global issue with major public health implications. Close to half of all child deaths in developing countries are attributed to malnutrition. Under-five mortality rate is persistently high in Ghana where mortality rates stand at 47.9 per 1000 live births. Malnutrition in early childhood results in physical and cognitive consequences with serious implications for health and economic development of nations. The Community-based Management of Acute Malnutrition CMAM is a major strategy adopted by the Ministry of Health, Ghana, to address severe acute malnutrition in children. The program involves four key components: community mobilization which involved community engagement and active case finding using the Mid-Upper Arm Circumference tape, a supplementary feeding program, outpatient therapeutic care which manages children with severe acute malnutrition using the Ready-to-use therapeutic food and inpatient care for children with acute malnutrition with complications. Since its inception in Ghana, there has been improvement in the cure rate of severe acute malnutrition, however significant disparities exist with its implementation nationwide. The goal of this study was to evaluate the implementation of the CMAM, a key national strategy intended to improve the nutritional status of children. The study utilised qualitative case study methodology to examine the implementation of the program. Twelve professional key informants and 24 mothers were purposively selected and interviewed. Observations were made at two nutritional centers, the Princess Marie Louis Hospital in Accra and the Kwahu West Municipality in the Eastern region of Ghana, and relevant documents were reviewed. Data generated from interviews were subject to content analysis. Six interconnecting strands emerged from the data synthesis and analysis of the policy implementation process: collaboration and stakeholder connections, funding and logistic nuances, human resource and capacity building, implementation dynamics, appraising the process and Beneficiary experiences. The study found that implementation of the CMAM program was fraught with several challenges including lack of funding and inadequate supply of logistics. There was incomplete program coverage which led to caregivers traveling long distances to access service, inadequate staffing and insufficient volunteers affected case search and follow up aspects of the program. Recommendations are made for the CMAM program to be incorporated into the National Health Insurance Scheme in order to maintain a sustainable source of funding for program implementation. Local production of the CMAM supplements may curb the problem of shortages in the supply of the supplements. Healthcare workers need to intensify education about child feeding practices. The study generates new insights that will inform future policies and programing for child nutrition in Ghana.