This study highlights critical findings regarding the nutritional quality, meal diversity, and implementation challenges of Ghana’s SMP. Meals typically have high nutrient density, varied quality of energy density and low dietary diversity. Further, the views of 129 caterers provided insights on challenges and facilitators to providing healthy school meals. Caterers reported food item cost and lack of food purchase guidelines as barriers to providing nutritious school meals. Food safety training and guidelines for food preparation were facilitators.
Serving nutritious school meals to meet increased nutrient requirements during key stages of growth and development remains a widespread challenge around the world and in Ghana (10). While GSFP menus were created to ensure that caterers have flexibility to account for food availability, local procurement and seasonality, the overall meal diversity in school children’s diets remains low, with starchy staples and pulses/nuts/seeds served most frequently. In addition, caterer compliance varied greatly, questioning the feasibility of even implementation of nutritious meals in the region. For example, the nutritional quality of meals decreased when lower nutrient dense meals based on starchy staples (e.g., white rice or Banku) were repeated during the week, and/or increased if animal food sources (e.g., meat and fish) were added. Varied sources of protein, such as beans, soya, egg, fish and meat were offered, but overall inclusion remained extremely low. Increasing protein content, both plant and animal- based sources (35) could positively impact nutritional status and overall health, especially as protein deficiencies in these age groups are linked with poor growth and delayed puberty (11). As beans are a staple on the district menus, prioritising their incorporation into dishes that children like, such as Waakye, can encourage protein intake and promote local and climate friendly food options. Increasing vegetables inclusion could also improve nutritional quality and create more opportunities for local food procurement with smallholder farmers, potentially reducing food cost. As few meal quality indexes are developed for school meals and even fewer validated in LMICs (36), using an unvalidated tool is a study limitation. It is also important to note that the evaluation of the school lunch represents one meal consumed per day, totalling five days per week, and may not necessarily reflect overall dietary quality.
The GSFP and district assemblies can use new standards set by the 2023 Food based dietary guidelines for Ghana as a tool to revise school menus, working alongside caterers to overcome challenges to promote access to optimal nutrient rich diets that are diverse, culturally relevant and ideally locally procured to reduce all burdens of malnutrition in school-aged children, spur local economies and promote climate friendly initiatives (21, 35). This is increasingly important as the GSFP continues to expand coverage in primary schools and scale up to secondary schools.
While GSFP caterers are paid employees, the amount allocated per student per meal is not enough to purchase ingredients, let alone to earn a salary, with some caterers using their own financial reserves to be able to provide school meals. This challenge was reflected in the nation-wide strike of school caterers (April 27 - June 22, 2023), where increased allocations per student (3.00 cedis, 0.22 USD) were requested to help overcome high food price inflation (59.3% in 2022) (37). The strike ended with an increase in allocated budget per student/per day from 1.00 cedi (0.072 USD) to 1.20 cedis (0.089 USD). The Minister of Gender and the School Feeding Secretariat also agreed to engage with school caterers to better understand their challenges (38).
Despite Ghana’s clear commitment to a successful national school meals scheme, the government does not publish national survey data and has abstained from participating in a recent global school meal survey (39), furthering challenges monitoring and evaluation efforts. Global trends suggest that 60% of special training for school cooks and caterers covers food safety and hygiene, while other training on nutrition, menu planning and portions/measurement are only included in about 40% of global programming (9). This may reflect why caterers in this study discussed food safety knowledge and practices more often than nutrition knowledge. This barrier could be minimised by the creation and implementation of tools to facilitate data collection on dietary recall and portion sizes in school meals, both in Ghana and similar contexts (35). For example, the newly available School Meals Planner tool, piloted in Ghana in 2012, can be used by the government and school caterers to plan out school meals that meet minimum nutritional requirements/30% RDA recommendations within allocated budgets (40). Additional tools such as the Food Recognition Assistance and Nudging Insights (FRANI) use artificial intelligence for food recognition and portion estimation to conduct dietary assessment in Ghanaian adolescent girls, which could be applied for widescale nutritional quality monitoring and evaluation of school meals (41). These tools should only be used if they facilitate implementation and evaluation without further complicating or overburdening programme coordinators and staff with additional responsibilities.
On policy and practice, the discrepancy between the planned menus and the meals provided points to a need for interventions that enhance the school meal provisioning compliance and enforcement mechanisms. Given the cost constraints, and a lack of clear procurement guidelines, Ghana’s current effort to develop a public food procurement and service policy may address this. Clearer food purchasing guidelines could help standardize meal quality across the program. These guidelines should be realistic, reflecting local market conditions and seasonal availability, to ensure that they are practical and applicable across diverse districts. Second, increasing the meal allocation beyond the current 1.2 Ghana cedis per child/per day could mitigate the financial barriers that prevent caterers from adhering to menu guidelines and enable them to include a wider variety of food groups, particularly fruits and animal-sourced foods, which are currently lacking. Earmarking GSFP meal allocation to the recently introduced sugar sweetened beverage taxes could be a potential path forward. Enhanced training for caterers, focusing on nutritional guidelines and cost-effective meal planning, could also improve compliance when coupled with regular monitoring and support to ensure that the knowledge gained is effectively implemented.
The study also highlights the need for further research into the operational challenges and behavioural aspects of GSFP implementation. Such studies may include qualitative research involving focus groups with caterers, teachers, and parents to provide deeper insights into SMP stakeholder’s perception, political, economic, cultural and social factors influencing meal provisioning. Investigating the challenges associated with incorporating locally sourced, cost-effective food items could also provide valuable data to support more sustainable and community-supported food systems, embodying homegrown school feeding programme ideals within the GSFP.