Beyond Pilot Projects: Why Ghana Needs Sustainable Financing for Nutrition at Scale
Ghana has made important progress in testing effective nutrition interventions. Multiple Micronutrient Supplements (MMS) have been piloted in selected health facilities across several districts, reaching thousands of pregnant women. Ready-to-Use Therapeutic Food (RUTF) has been delivered through community programs in high-burden districts, supported by trained health workers. These initiatives demonstrate that proven nutrition interventions can be implemented successfully within Ghana’s health system.
However, pilot projects are designed to test feasibility, not to meet national needs.
Despite their success, current pilots reach only a small fraction of the women and children who require these services. Meanwhile, anemia affects a large proportion of pregnant women, and tens of thousands of children suffer from severe acute malnutrition each year. The gap between pilot coverage and population need highlights the limits of project-based approaches.
Nutrition projects funded through time-bound grants face predictable constraints. Coverage depends on donor priorities rather than national burden. Programs end when funding cycles close, even if needs persist. Financing uncertainty makes long-term planning difficult, and supply chains often remain fragmented instead of being integrated into national systems. Data collection and accountability focus on project requirements rather than strengthening national monitoring.
Most critically, project-based approaches perpetuate inequity. Women and children in pilot districts receive evidence-based interventions while those in non-pilot areas with identical needs receive outdated or no care. Access becomes a matter of geography rather than health policy. This creates a two-tier system where donor program placement, not health policy, determines who receives lifesaving treatment.
Systems-based financing through the National Health Insurance Scheme offers a fundamentally different approach. NHIS integration ensures nationwide coverage based on enrollment rather than project geography. With 84% of mothers with children under five already enrolled, the delivery infrastructure exists. Financing becomes predictable through established NHIS revenue streams. Supply chains integrate with national pharmaceutical procurement systems. Quality standards and accountability mechanisms operate across all facilities, not just pilot sites.
Transitioning from pilot to scale requires policy decisions that projects alone cannot deliver. RUTF and MMS must be formally included in NHIS benefits and medicines lists. Reimbursement rates must be established to cover procurement and distribution. Budget allocations must be protected within medium-term expenditure frameworks. Supply chains must be strengthened at national level rather than replicated across multiple projects.
Ongoing Health Technology Assessments will deliver crucial evidence about cost-effectiveness to guide future decisions. Available data already suggests that MMS is highly affordable within public-sector financing, while community-based treatment of severe malnutrition reduces reliance on costly hospital care. These interventions are not only effective, but they are also fiscally realistic.
Pilots have served their purpose. Continuing to operate at pilot scale when national implementation is feasible means accepting preventable illness and loss of human potential. Ghana has the policy frameworks, trained workforce, and financing mechanisms required to move forward. What remains is the decision to shift from demonstration to delivery, and to ensure that effective nutrition interventions reach everyone who needs them.
Feature article by Women, Media and Change under its Nourish Ghana: Advocating for Increased Leadership to Combat Malnutrition project
