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Implementing Social Marketing for Improved Nutrition

Ghanians making fufu, Photoshare


Malnutrition is a major contributor to the global burden of disease, accounting for over 1/3 of child mortality.  Chronic undernutrition is the major cause of wasting and stunting among children in developing countries. Micronutrient deficiencies such as Vitamin A, iodine, and iron all have serious and wide range effects on health, cognitive abilities and mortality. In Ghana, 40% of all deaths under 5 are due to undernutrition, making it the leading cause of child mortality. Vitamin A deficiency still affects 72% of the under 5 population in Ghana, and rates of iodine deficiency remain high in one third of its districts. Proper nutrition in Ghana is not only a determinant of the physical and mental development of children but it also impacts their susceptibility to disease, educational attainment and economic productivity.
To improve nutrition in Ghana, attention has turned to fortified complementary foods and nutrient supplements which more effectively meet the nutritional needs of children between the ages of 6 and 24 months. Many of these specialized products have been developed and tested in Ghana, but were ultimately not sustainable due to cost and availability. To address this challenge, a social marketing initiative for the “KokoPlus” supplement, was designed to establish a market-based distribution model which would complement the existing NGO supported delivery system. The study devised and evaluateed a demand creation strategy with potential to be implemented at scale in other West African countries.


Ghana: Akwapim South, West Akim, Suhum Kraboa Coaltar districts


The aim of this study was e to answer these research questions:
  • What are effective routes to promoting better quality diets for infants and young children in Ghana?
  • Does community and personal engagement through social marketing result in behavior change in rural districts of Ghana?
  • How does the market-based approach and commercialization of the KokoPlus nutrition supplement impact awareness, coverage and behavior change?


This research has focused on distribution and demand creation. The nutritional supplement "Koko Plus" is intended to be added to fermented corn dough.  This dough is a common food for infants and children 6-24 months of age.  Usage of this product requires behavior change and product substitution (Koko Plus replaces sugar in koko), therefore an effective marketing and promotion campaign was the first step to the successful commercialization of the product.  Through community engagement, demand creation efforts were achieved by focusing on target audiences; caregivers, pregnant women, heads of household, opinion leaders and sales personnel. The value proposition to move to a fortified sugar-based commodity was reinforced by the involvement of these community leaders through various marketing and promotion events. Through audits, interviews and spatial surveys (of caregivers and children), ESM has analyzed awareness, coverage and usage of Koko Plus throughout the three districts. GAIN has started a cumulative evaluation of ESM’s social marketing approach to Koko Plus implementation and coverage within the target population.


The brand and slogan are becoming entrenched in the community as a solution to improve their children’s health. The study found that:
  • About 62% of all surveyed caregivers had ever heard of Koko Plus
  • about 23% of all surveyed children had ever taken Koko Plus,
  • and about 15% of surveyed children had used Koko Plus in the last 7 days.


The supplement is being added to foods other than Koko, or sometimes eaten straight from the sachet without being added to a startup food. Some retail shops are resisting in selling Koko Plus due to market competition, confusing product display, or without an explanation. Holidays, weather and overlapping campaigns interfere with promotional and marketing activities. Based on study findings and lessons learned at the end of the implementation phase, the social marketing approach to nutrition supplement implementation has increased awareness and usage of Koko Plus. This implies that the model could be scalable in other West African countries with a high prevalence of childhood mortality and morbidity from poor nutrition. It will be important to maintain the local ownership of the Koko Plus promotion and usage so that over time it becomes a part of the fabric of the community, and a norm in cultural and food practices. 


This study aligns with a spectrum of Ghanaian and international efforts to reduce malnutrition; from Ghana’s draft of a National Nutrition Policy to the Scaling Up Nutrition Movement (SUN) and UN Millennium Development Goals. The findings and lessons learned from this research will contribute to the development of successful nutrition supplement implementation strategies in other West African countries, and ideally the gradual improvement of infant and child nutrition across their populations. 


Exp Social Marketing Foundation
Managing Director: Richard Burns


Project status at implementation

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