Participation was received from eighteen (18) of the twenty-six (26) invited respondents; giving a general response rate of 69.23%. This response rate was higher than that usually obtained for online/email-based surveys. Of the participants, nine (9) 52.94% were males and 8 (eight) females 47.06% and the participants were average aged 44.88±10.41 with

most being in the age category of above forty (40) years with a total of two hundred and fifty-two (252) years of experience between them. Out of the criterion participants expressed, twenty (20) 25% were categorised as resource issues and eighteen (18) 22.5% were categorized under political commitment, with fifteen (15) 18.75% falling under acceptability issues. The remaining criteria were either categorized under sustainability issues with fourteen (14) respondents making 18%, twelve (12) respondents under stakeholders’ commitment and impact issue having the least number of two (2).

Considering the complexity of issues such as acceptability, categorization decisions under each issue was based on multiple consideration for both the name and definition of the criterion from the stakeholder’s perspective. The criteria were grouped into the respective issues based on the definition of criteria provided by the participants through the interview and not necessarily just the name of the criteria. No participant evaluated the options by using more than 5 criteria.

To determine relative degree of importance of each criterion, stakeholders were asked to weight the criteria. Resources obtained the most weight across perspectives. Stakeholders’ commitment being the least selected issue for evaluation of the predefine option. The wide of lengths of graph bars indicate wide variance in the degree relative importance in evaluating of the options. The bands illustrate the highest and lowest weighting of participant’s criteria with the Issue, illustrating the degree of agreement (narrow band) on the relative importance of criteria within each Issue.

In the group interviewed, there is general belief that investing in nutrition is critical and cannot be over-emphasized. Nutrition potentially helps to achieve not only public health impact but results in the creation of social safety nets, growth of agribusiness, but also helps to reduce cost of health (present and future) and ultimately achieving the SDGs. To do this, the participants provided the following insights.

Nutrition and nutrition agenda must be made a priority at the national and political levels. It would be too idealistic, however, to expect policy and decision makers to automatically understand the importance of nutrition. This can be done by creating enabling environment within political and policy processes that build and sustain momentum for the effective implementation of actions that reduce malnutrition. Rather than wait for political will to emerge generic, political momentum can be developed and sustained through deliberate action such as the following. Streamlining financing

and budgeting for nutrition activities towards a food-system approach which looks at financing for all nutrition-related activities (both nutrition-specific and nutritionsensitive) across all sectors.

As the Ghana national nutrition policy is now in place, there is a need to consolidate this effort with creation of a Nutrition Commission or Council. This body will bear the mandate and power to facilitate, coordinate and monitor all nutrition activities across all sectors and actors. This is to ensure adequate coverage tracking, monitoring and evaluation across the various pockets of nutrition strategies being carried out nationwide. The current vertical style of nutrition programming model, where unilateral decisions are made in national office and trickled down to the district and local level does not adequately address the day-to-day dynamics of nutrition vulnerability.

Micronutrient survey was viewed a step in the right direction. Additional Research was seen as fundamental to evaluate the short falls of past nutrition strategies, adapt current strategies to the everchanging Ghanaian nutrition landscape as well as help in the development and implementation of more resilient future nutrition strategies for Ghana. Research that will extend to providing guidelines and best practices for all nutrition activities carried out by international and national level actors. This is very important in for nutrition surveillance. Research is also required for national early

warning systems and nutrition emergency.

At least two (2) out of every four (4) stakeholders interviewed reiterated the importance of nutrition education influence of the success of any nutritional strategy. Nutrition education is essentially for promoting consensus between stakeholders, influencing policy design and changing consumers’ behaviour and nutritional environment.

Participants opined that nutrition education/promotion will be improved if the following actions were implemented: The establishment of national guidelines/legislature that create an enabling environment for nutrition education to able influence public policies and programming. Research-informed guidelines that promote access to a variety of nutritious local foods, address of the barriers to nutrition and move beyond from individual behaviour change advocacy and information transmission as the only approach, but extend to environmental supports, organisational change, advocacy and policy/legislature that work collaboratively across sectors and with social networks.

A centralised national administrative (intersectoral multiagency) taskforce that will develop national nutrition messages, vets at all national nutrition education and behaviour communication messaging to ensure coherent, persuasive messages with

National Nutrition Policy and National Nutrition Action Plan. There should also be national system of identifying, reporting misinformation and correcting wrong nutrition message especially in hindsight of the impact of nutritional misinformation during the Covid -19 pandemic.

Institutionalising knowledge of the nutritional value of foods and awareness on the importance of nutrition in health by Early incorporation of comprehensive nutrition as a subject/course in national basic primary school through reviewing and revision of the curriculum. Incorporation of nutrition-related information at various level throughout secondary school academic environment. Teaching and learning methods employed should reinforcement scientific evidence relating to the food quantity, quality, safety and nutritional content. Adding nutrition to the essential curriculum courses required in the training of professionals in teaching, agriculture, food, environmental, health and medical education. Behaviour change champaigns must adopt of innovative communication, interactive teaching and learning strategies and technologies that are

creativity to guide the design, development and dissemination of innovative and useful messages; especially communication technology which includes both mass media, folk media and person-to-person.

Stakeholders also recognized that women are extremely important contributors in food and agricultural systems and nutrition sectors. Yet very often political, sociocultural and traditional norms often result in women having limited decision rights at national nutrition strategies decision making levels (generally controlled by men) and are often relegated to implementation level of nutrition programming. The belief is that there are opportunities to do more to understand the basis for the power imbalances at the national and identify current status of women and women’s organizations in decisionmaking, (existing institutional policies demanding female involvement in decisionmaking

and the progress made) and invest in targeted action to promote women’s leadership that strengthening women’s roles in decision-making. In order for women to garner some power and thrive, stakeholder organizations need to elevate an agenda that caters for women’s agency and autonomy.

A central assumption realised among participants is the question of nutrition strategies should be focused on short term result of long-term rewards. Participants were mainly concerned with vulnerable population sub-groups at risk or already suffering from malnutrition, and whether strategies would be working more actively to prevent malnutrition and promote the knowledge, skills, and supports which will enhance and sustain good nutritional health. Participants believed that target supplementation despite its problems with targeting is a relative effective strategy in the treatment of acute malnutrition across vulnerable groups. In this way, supplementation is very important short-term measure in malnutrition alleviation as part longer-term health care programmes or whilst planning for long term nutrition specific programmes such as fortification. Despite the recognition of fortification’s importance, fortification-related strategies efforts were ranked relatively low by participants. Participants were wary about cost effectiveness, poor education campaigns, laxed monitoring and enforcement of legislation.

In Ghana, the integrated approach within the national stakeholders interviewed has not been without its short-falls, Stakeholders however seem optimist that integrate strategies are the way forward for nutrition programming in Ghana and the need to look at it from a multisectoral food system approach that require a combination on preventive and curative strategies (package of nutrition-specific and nutrition-sensitive interventions).

Reversing these current short falls is not impossible, and can be achieved with an systematic analysis of the broader spectrum nutrition drivers(socio-economic, biophysical, technological, political, demographical, cultural resources) and linking these drivers to more immediate factors (water supply , sanitation, and hygiene, and gender equity, dietary preference and household food distribution behaviour) affecting food affordability availability, accessibility, and safety at the national, regional and household level. To adequately do this, will require stakeholder engagement and joint efforts from various sectors including but not limited to agriculture, health, social welfare, education, and finance to harmonise efforts at various stages of programming: from creation/ inception and policy design to implementation, monitoring and scaling up.