Strengthening nutrition programs in West African countries
The Governments of Senegal, Ghana, and the Gambia sought to strengthen their capacity to reduce rates of malnutrition. Through a series of peer reviews in nutrition, officials from these countries identified new directions for reform, and enhanced their skills and commitment to design nutrition programs. They also integrated lessons from these reviews in the design World Bank-financed nutrition projects.
The Governments of Senegal, Ghana, and the Gambia sought to reduce rates of chronic malnutrition, which threatened their citizen’s health, livelihoods, and quality of life. With support of the World Bank and donors, officials from these countries developed national nutrition policies, put in place plans to combat malnutrition, and designated units and programs to accelerate progress in nutrition.
However, country officials confronted diverse factors impeding gains. Weak management of nutrition policies and programs across sectors had led to program fragmentation and duplication. Health agency staff had inadequate skills to design, administer, and manage nutrition policies and programs. They also lacked awareness of global good practices, especially in multi-sector coordination, use of public private partnerships (PPPs), and decentralization of nutrition programs to local communities.
In 2011, the World Bank and other donors were supporting nutrition programs in West Africa, including World Bank investment projects in these three countries. Bank and country officials recognized that each country had lessons to share on nutrition. For example, Senegal was a leader in multi-sector coordination and decentralized management, Ghana in community-based service delivery, and the Gambia in community mobilization and political commitment.
To facilitate knowledge sharing on such topics, the Bank helped organize a series of expert visits between these countries, allowing visiting delegations to review a host country’s challenges, and identify recommendations for the host. These so-called “peer reviews” aimed to identify common challenges and solutions, build a country’s commitment for nutrition programs, and increase its operational capacity to scale-up nutrition initiatives. The West African Health Organization (WAHO) of the Economic Community of West African States (ECOWAS) helped organize these visits.
Participants in these peer reviews commonly included 5-6 officials from the visiting country’s Ministry of Finance and other line ministries; national agencies; and non-governmental associations. The peer reviews that took place in 2012 are below:
- Ghana to Gambia (February)
- Senegal to Ghana (March)
- Gambia to Senegal (April)
- Gambia to Ghana (September)
- Ghana to Senegal (November)
The reviews normally began with a consultation between the visiting delegation and the host country’s nutrition unit or department, followed by field visits to conduct interviews and learn about the country’s implementation process and challenges and successes. Visiting delegations also met with national stakeholders and development partners to discuss multi-sector coordination and funding.
At the end of each visit, the delegation offered a high-level debriefing for the host country’s nutrition unit and stakeholders, where they presented a report outlining recommendation on areas for improvement, which was expected to increase traction for reform.
The peer reviews increased the capacity of agencies and officials from these countries to design, manage, and administer nutrition policies and programs. For instance, the exchange helped to:
- Increase officials’ awareness of new approaches for designing nutrition programs, particularly those that engage local governments and communities, and use public-private partnerships (PPPs).
- Strengthen high-level commitment to support reforms in nutrition. For example, referring to the Gambia – Senegal peer review, one participant suggested that “the peer reviews strengthened relationships with Ministries of Finance. . .Gambia’s MoF can now make the case that since Senegal is supporting nutrition in its Ministry, why not the Gambia?’”
- Enhance officials’ skills to implement nutrition programs in ways not possible from traditional technical assistance. Wilhelmina Okwabi from Ghana’s Nutrition Unit suggested that “the reviews presented and opportunity to widen one’s scope…and the field visits…revealed things that are not seen in written reports.”
Since the exchange, officials have taken steps to implement recommendations made by visiting delegations. Among other things, Senegal and the Gambia have increased their budget allocations for nutrition programs.
- Supporting an exchange between countries in the same region under the auspices of a regional organization can build trust and ensure an exchange’s sustainability.
- Involving multiple countries in a coordinated exchange program can be logistically difficult. For example, Burkina Faso, which was expected to be a fourth country in this exchange, was dropped due to scheduling hardships.
- Peer review exchanges should focus on what a visiting delegation can learn from a host country. The original design of the peer reviews in this exchange foresaw that visiting delegations would mainly share know-how with host countries. However, in practice, the visiting delegations learned more from the host country than vice versa.
- It is important to link an exchange to a broader donor or government-supported initiative, particularly to ensure funding is available for follow-up activities.
Bank staff leveraged their regional work and contacts to broker this exchange and finance it with a US$116K grant from the South-South Facility. Funds from the South-South Facility funded the travel and accommodations of the country officials in the five peer learning sessions.
The exchange’s sponsors included the World Bank and the West African Health Organization (WAHO). The key organizations from each country that provided knowledge included:
- The Ghana Health Service
- Senegal’s Cellule de Lutte contre la Malnutrition
- The Gambia’s National Nutrition Agency (NANA)
As a result of this exchange, officials from Ghana, Senegal, and the Gambia prioritized coordinating with one another on trade-relate nutrition policies, broadening partnerships, and continuing use of South-South Knowledge Exchange to deepen learning.
Learning from this exchange is expected to inform the designs of new government and donor initiatives. For example, in Senegal, the Government may incorporate lessons in a new Bank-financed Health and Nutrition Project. In Ghana, lessons were incorporated in a new Maternal and Child Health and Nutrition Project. In the Gambia, officials are expected to follow-up on a Rapid Response Nutrition Security project with the preparation of a new Maternal and Child Nutrition and Health Results Project.
The members of the visiting delegations for the first four peer reviews are mentioned below:
Ghana to the Gambia (February 2012)
- Mrs. Wilhelmina Okwabi, Head of Nutrition Dept., Ghana Health Service & Nutrition Focal Point for ECOWAS Nutrition Forum
- Mr. Dennis V. Gbeddy, District Director, Ghana Health Service
- Ms. Paulina Addy, Head of Food Security Unit, Ministry of Food and Agriculture
- Mrs. Mary Mpereh, Nutrition Focal Point, National Development Planning Commission
- Ms. Nana Ayim Poawwa, Hunger and Malnutrition Focal Person
- Mr. James Krodua, World Bank Nutrition Desk, Ministry of Finance
Senegal to Ghana (March 2012)
- Mrs. Ndèye Mayé Diouf, Ministry of Finance,
- Mrs. Mame Mbayame Gueye Dione, Ministry of Health
- Mr. Adama Nguirane, Project Manager, Association Régionale des Agriculteurs de Fatick
- Mr. Abdoulaye Ka, National Coordinator, Cellule de Lutte contre la Malnutrition
Gambia to Senegal (April 2012)
- Mr. Modou Cheyassin Phall , NaNA
- Mr. Bakary Jallow, Principal Programme Officer, NaNA
- Mr. Dawda Joof, Action Aid International
- Mr. Suwaibou Barry, Ministry of Finance and Economic Affairs
- Dr. Mamady Cham, Director of Health Services
- Mr. Jankoba Jabbie, Regional Health Director, Lower River Region
Gambia to Ghana (September 2012)
- Mr. Modou Cheyassin Phall, Executive Director, NaNA
- Mr. Bakary Jallow, NaNA
- Mr. Dawda Joof, Action Aid International The Gambia,
- Mr. Swaibou Barry, Ministry of Finance and Economic Affairs
- Mr. Alhagie Sankareh, Ministry of Health and Social Welfare
- Mr. Dawda Ceesay, Ministry of Health and Social Welfare
- Mr. Musa Humma, Ministry of Agriculture
- Dr. Momodou Darboe. Medical Research Council.
- Knowledge Exchange Completion Report