Nutrition-sensitive lockdowns: conceptual framework and empirical insights from Africa during COVID-19.

Motivation: Countries facing challenges of nutrition security confront a trade-off when dealing with pandemics such as COVID-19. Implementing lockdown measures, widely used worldwide, can help "flatten the curve" (of disease), but such measures may worsen nutrition security. Purpose: We aim to identify and justify nutrition-sensitive lockdown measures to reduce trade-offs with nutrition security. Methods and approach: We propose a conceptual framework which distinguishes eight lockdown measures and six pathways to nutrition security. To demonstrate the relevance of the pathways, we reviewed emerging literature on COVID-19 and nutrition security. We analysed the content of 1,188 newspaper articles on lockdown effects in five African countries - Benin, Ghana, Kenya, Uganda and Zambia. Findings: Some lockdown measures, such as closing workplaces and restricting movement, potentially worsen nutrition far more than others - banning events and public gatherings have far lesser impacts on nutrition. This can be seen from the framework, literature, and is supported by the analysis of newspaper reports in the five countries. Policy implications: It is better when possible to test and trace disease than to lockdown. But when lockdowns are needed, then first recourse should be to measures that have few nutritional consequences, such as banning public events. When more drastic measures are necessary, look to mitigate nutritional harm by, for example, exempting farm labour from restrictions on movement, by replacing school meals with take-home rations, and, above all, providing income support to households most affected and most vulnerable.

'We would rather die from Covid-19 than from hunger' - Exploring lockdown stringencies in five African countries.

Facing COVID-19, African countries were confronted with a dilemma: enacting strict lockdowns to "flatten the curve" could potentially have large effects on food security. Given this catch-22 situation, there was widespread concern that Africa would suffer most from the pandemic. Yet, emerging evidence in early 2021 showed that COVID-19 morbidity remained low, while "biblical famines" have been avoided so far. This paper explores how five African countries maneuvered around the potentially large trade-offs between public health and food security when designing their policy responses to COVID-19 based on a content analysis of 1188 newspaper articles. The findings show that food security concerns played an important role in the public policy debate and influenced the stringency of lockdowns, especially in more democratic countries.

Evaluation of facilitative supervision visits in primary health care service delivery in Northern Ghana.

BACKGROUND: In Ghana's health delivery services, facilitative supervisory visit (FSV) as a system of management is new. This paper presents the standard evaluation results of FSV, which formed an integral part of the community-based health planning services (CHPS) initiative. METHODS: The study was conducted in the Upper West Region of Ghana. The Project developed guidelines and tools for FSV for four different health system levels--regional, district, sub-district and community levels. Electronic data from all four levels representing quarterly results were compiled into their annual equivalents, and summarized graphically for comparison. RESULTS: The data show that all the nine districts embraced the FSV concept even though they differed markedly with regard to the degree of adherence to some set benchmarks. Three DHMTs (Wa Municipal, Lawra and Jirapa) were graded as good while the remaining six DHMTs were adjudged as fair in relation to management of supplies, transport and equipment, information, meeting, and technical support. CONCLUSIONS: The data further suggest that there is much to gain both individually and institutionally from FSVs. Generally, FSVs are crucial to the delivery of primary health care services in especially rural areas.