Ghana GMP Health Worker counseling a young mother
Photo Credit: Kamal Deen Djabaku

Globally, 178 countries use growth monitoring and promotion (GMP) as an entry point for preventive care and essential child health, nutrition and development services. Growth monitoring, the first step, consists of monthly contact and an assessment of growth, the pattern of weight most commonly and sometimes height/length. Growth promotion links the growth trend with a target action through tailored counseling and referral, as needed. These actions support children’s optimal growth through increased caregiver awareness and attention to child growth, improved caring practices, and increased use of other services.

During a 2018 convening led by the Global Financing Facility of the World Bank Group, the United Nations Children’s Fund, the Bill & Melinda Gates Foundation, and The Manoff Group, global thought leaders recommended a paradigm shift to reposition GMP to better integrate child growth and development in the first years of life and strengthen the promotion element. They also called out the need to tailor GMP programs and activities to different development, geographic, and cultural contexts.

Learning from GMP in Northern Ghana and Nepal

USAID Advancing Nutrition responded to this call through a two-country case study in northern Ghana and Nepal designed to understand how health facilities and outreach service points implement GMP in two different contexts and draw out important lessons for other countries. The project’s technical experts reviewed programmatic and peer-reviewed literature; interviewed national and subnational stakeholders, health workers, and caregivers; and observed GMP sessions at facility and outreach sites. These findings will be used to inform technical assistance and spark conversations about next steps for strengthening GMP.

  • GMP is an important platform for delivering core health and nutrition services and promoting child growth and development. Facility and community points offer GMP with other key health and nutrition services such as immunization, vitamin A supplementation, and sick child care to maximize coverage. Caregivers want to know about their children’s growth and development.
  • Health workers in both countries measured weight. For most children regularly measured, health workers used the growth trend (the growth pattern over time) for counseling. When children did not have regular measures, health workers could not identify growth faltering so instead focused their attention on children who were already malnourished based on their current weight or mid-upper arm circumference.
  • Health workers in both countries used systematic procedures to record growth monitoring data through the District Health Information System (DHIS)2, where aggregate data recorded in registers are uploaded to a digital platform by health facility staff. All levels of government view data entered in DHIS2. Generally, data informs programming decisions such as allocation of resources. In comparison, growth promotion data are not tracked systematically.
  • The quality of promotion, including tailored counseling based on the child growth trend, varied between the two countries and across study sites within countries. There is a lack of clarity around “promotion,” especially as distinguished from growth monitoring. Despite the ambiguity, health workers in both countries described some key elements of promotion (e.g., communicating results to parents, referring children for additional services, etc.). Health workers tailor counseling to the individual child and their growth trend where conditions permit; caregivers and children must attend regularly to establish a growth trend and health workers must have sufficient time to spend with each child. Tailored counseling efforts could continue to flourish with recognition of health worker strengths and adequate support.

  • Empower families through active engagement in their child’s growth and development to drive demand. Promote regular participation beyond when their child is sick or due for immunization. Caregivers in both contexts expressed a desire for more information on how their child is developing and how to play and interact with them.
  • Develop growth charts designs that help the health worker interpret the growth trend rather than focusing only on the single-point-in-time nutritional status (normal or low weight-for-age).
  • Lighten and streamline health worker workloads with task sharing mechanisms and decision logic job aids that help them focus on the children most at risk of malnutrition—those who are growth faltering—or facing developmental delays.
  • Leverage ongoing home visits to follow up with children who are most at risk of malnutrition or developmental delays in addition to those already malnourished. Use home visits to understand the home environment, problem-solve context-specific issues, and engage family members.
  • Regularly track and use growth data to mobilize community support for action, accountability, and resource allocation. Growth data can help health workers identify useful group counseling topics, decide which geographic areas need special attention, assess program reach, whether GMP attendance targets were met, and lobby for additional resources.

For more detail on these findings, check out our country narrative summaries (Northern Ghana and Nepal) and stay tuned for an upcoming manuscript contextualizing these findings based on critical points for strengthening GMP identified during the 2018 convening.

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