At the first N4G Summit in 2013, 110 stakeholders committed to prevent at least 20 million children from being stunted – saving at least 1.7 million lives by 2020. These commitments deliver much-needed action on policy and financing commitments to the Sustainable Development Goal (SDG) 2—Ending Hunger in All its Forms—which is an underlying driver of 12 of the 17 SDGs. As we continue the Nutrition for Growth Year of Action, take a look at how pledges made during the N4G summits in London (2013) and Milan (2017), have brought about positive impacts on global nutrition.
According to the latest Ghana Demographic and Health Survey (2014), nearly 1 in 5 children under age 5 is stunted. The Ghana Nutrition Improvement Project (GNIP) aims to solve the problem of stunting during the weaning period (from 6 months to 2 years of age), which is caused mainly due to the insufficient content of essential nutrients in the traditional complementary food “koko” (fermented corn porridge). The mission of GNIP is to create a “Social Business Model” for improving child nutrition in a sustainable way without continuous aid. The Ajinomoto Foundation (TAF), a public interest foundation, acquired GNIP in 2017, after its launch in 2009 by Ajinomoto Co. Inc.,1 a global food and amino acid company. TAF is not involved in business but supports local partners to establish sustainable business.
TAF has been working to improve the nutritional status of infants in Ghana through the introduction of a complementary food supplement named “KOKO Plus.” KOKO Plus is produced locally using locally available ingredients (soybean) supplemented with micronutrients and lysine to improve the amino acid balance. KOKO Plus is an evidence-based product (World Food Programme [WFP] registers KOKO Plus as a “Nutritious powder” in its food basket) and is designed to meet local needs: it is affordable (USD 0.10 /sachet /day); acceptable (for local tradition and preferences); and accessible (available in kiosks near health facilities and with a one-year shelf life).
A sustainable social business model should be scalable and inclusive, meaning that all processes from product development, production, and distribution would be primarily carried out by local people. GNIP officially collaborated with Ghana Health Service (GHS) (concluding Memorandum of Cooperation in 2018) to co-create nutrition education tools and design a behavior-change process that applies the private sectors’ marketing intelligence. The process centers on a cycle of Awareness, Understanding, and Action. Health workers monitor and record children’s nutritional status (Awareness), and then they use simple pictures to educate mothers about basic nutrition knowledge and introduce KOKO Plus as a practical solution to improve child nutrition (Understanding). Once mothers understand the importance of nutrition and how to improve it, they get interested in KOKO Plus, and they purchase it from shops at the nearest health facility (Action).2 Mothers continue to use KOKO Plus once they see their children’s improved growth, and they become more confident. This cycle (Awareness, Understanding and Action) continues monthly and reinforces the mother’s behavior change.
Collaboration with GHS started in 2018, and in 2019, an estimated 47,000 beneficiaries (children fed KOKO Plus) and 3,000 nurses participated in the collaboration. The number of beneficiaries is expected to increase to 450,000 children by 2023. The growth in the number of beneficiaries has been significantly accelerated. The following factors contributed to this success:
- A science-based product respecting local needs
- Promoting inclusiveness of businesses and increasing local employment (including women entrepreneurs in rural areas: in collaboration with an international NGO in the Northern Region)
- Creating an effective behavior change cycle for mothers by applying marketing strategies
- Establishing value chain of the product to reach mothers who are educated about nutrition knowledge.
For the successful duplication or scaling up of the public-private partnership (PPP) model, it is important to establish a memorandum of understanding/cooperation at the national level; additionally, to execute the collaborative activities, it is also essential to have mutual communication on the ground at the regional and district levels. By openly sharing challenges/problems and understanding the competencies/assets of each party, we could work together successfully and produce genuinely synergistic impacts.3
We believe our efforts with KOKO Plus will contribute to strengthening the nutrition services of GHS’s health facilities, and after scaling up in Ghana, will eventually contribute to establishing Universal Health Coverage by duplicating this PPP model in other countries, which is an ultimate goal of Sustainable Development Goal 3.
1. GNIP was launched as a joint project among Ajinomoto Co. Inc., the University of Ghana, and the International Nutrition Foundation.
2. In 2018 we began a new collaboration with WFP to reach mothers who cannot afford to buy “KOKO Plus.” This new PPP utilizes a market based approach: mothers are identified and registered at health facilities (supported by GHS) and issued e-vouchers. Then they obtain “KOKO Plus” through the commercial supply chain in intervention areas. This collaboration with WFP was the first of a new type of PPP grant introduced by the Japanese Ministry of Foreign Affairs (MOFA), in which MOFA supports collaborations between international organizations and the Japanese private sector and NGOs. In FY 2018, a total of 68 projects have been carried out with 14 international organizations through this new grant program.
3. The term “Genuinely synergistic impacts” is based on Principle 3 for motivating multisectoral action in the Declaration of the Initiative for Food and Nutrition Security in Africa (IFNA), which was organized by the Japan International Cooperation Agency (JICA) in 2016. JICA is active in PPP and created a PPP-type grant program since 2010. GNIP was adopted as one of the first 2 projects related to health.
- Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial (2021)
- Development and Sensory Shelf-Life Testing of KOKO Plus: A Food Supplement for Improving the Nutritional Profiles of Traditional Complementary Foods (2019)
- A macro- and micro-nutrient fortified complementary food supplement reduced acute infection, improved hemoglobin and showed a dose response effect in improving linear growth: a 12 month cluster randomized trial (2019)
- Effect of the provision of a macro- and micro-nutrient fortified complementary food supplement on nutritional status of Ghanaian infants (2017)
- Assessing Program Coverage of Two Approaches to Distributing a Complementary Feeding Supplement to Infants and Young Children in Ghana (2016)
- Fostering reflective trust between mothers and community health nurses to improve the effectiveness of health and nutrition efforts: An ethnographic study in Ghana, West Africa (2016)
- Effect of a macro and micronutrient fortified complementary food supplement (KOKO Plus) on linear growth of children 18 months of age in Ghana ( 2016)
- Role of Protein and Amino Acids in Infant and Young Child Nutrition: Considerations for the Development and Delivery of High Quality Complementary Food Supplements (2015)
- Optimization of the nutrient content and protein quality of cereal–legume blends for use as complementary foods in Ghana (2014)
- Improving complementary feeding in Ghana: reaching the vulnerable through innovative business – the case of KOKO Plus (2014)
- Effect of lysine supplementation on health and morbidity in subjects belonging to poor peri-urban households in Accra, Ghana (2010)
- Satoru Okonogi, Takeshi Sakurai, and Reginald Adjetey Annan (2020) Improving Infant Nutrition through the Market: Experimental Evidence in Ghana, Working Paper No. 20-F-01, Department of Agricultural and Resource Economics, The University of Tokyo.(2020)
- CARE International
- ESM (social marketing company headquartered in South Africa)
- EXP (marketing company headquartered in South Africa)
- Ghana Health Service (GHS)
- International Nutrition Foundation (INF)
- Japan International Cooperation Agency (JICA)
- Japanese Organization for International Cooperation in Family Planning (JOICFP)
- Ministry of Foreign Affairs of Japan
- University of Cape Coast
- University of Ghana
- University of Tokyo
- World Food Programme（WFP）
- Yedent Agro Group