Nutritional quality and diversity in Ghana's School Feeding Programme: A semi-quantitative exploration through caterer interviews in the Greater Accra Region

Abstract Background The Ghana School Feeding Programme (GSFP) provides public primary school pupils a free daily meal. Each meal is expected to follow set menus to provide 30% of recommended dietary allowance for children (6-12y). This study assesses the nutritional quality and diversity of GSFP meals planned at the district level and provided at the school level, and engages school caterers to identify ways to enhance meal quality. Methods A multistage sampling approach was used to select 129 schools implementing the GSFP in six districts of the Greater Accra Region. School caterers were interviewed using a semi-structured guide. District level school menus were collected from the GSFP secretariat. Nutirional quality was evaluated based on nutrient profiling methods: energy density (low < 125kcal/100g; medium 125-225kcal/100g; high > 225kcal/100g) and nutrient density (low < 5%; medium 5–10%; high > 10%). Meal diversity was assessed by a simple count of food groups using a list of 5 groups: cereals, pulses/nuts/seeds, vegetables, fruits, animal-source food. Caterers’ views on programme facilitators and barriers were also explored. Results Planned school menus included 14–20 weekly options, composed of eight minimally processed traditional dishes. All meals, except white rice, had a high nutrient density/100g. Energy density was varied (low, n = 2; medium, n = 2; high, n = 4). Meals included only 2 or 3 food groups, mainly starchy staples, pulses/nuts/seeds, and sometimes vegetables. Fruit was never reported. About half of caterers reported deviating from the planned menus: 11.7% served alternative meals, with some including animal-sourced food (17%) and 39.4% repeated meals during the week, often based on starchy staples, influencing overall nutritional quality. Most caterers reported food item cost and lack of food purchase guidelines as barriers to providing school meals, while food safety training and guidelines for food preparation were facilitators. Conclusions While school meals are composed of minimally processed, nutrient dense, local foods, none met minimum food group recommendations, a goal that should be prioritised. Caterer compliance to planned menus varied greatly, reflecting recent food price inflation. Upwardly adjusting the current meal allocation of 1.2 cedis (0.22USD) per child per day) could enhance access to more affordable and nutritious foods in school meals.