How A Digital Tool May Help Health Workers Improve Growth Monitoring and Promotion and Reduce Malnutrition

By Rosie Eldridge , Nutrition and Health Systems and Early Childhood Development Project Coordinator; Courtney Meyer, M.Sc. , Publications Manager; and Sascha Lamstein , Senior Technical Advisor, USAID Advancing Nutrition

Implemented by health workers around the world, growth monitoring and promotion (GMP) is an approach that has the potential to prevent malnutrition. Identifying and addressing health risks, like growth faltering, before they become more serious problems is at the heart of the GMP approach. GMP involves routinely measuring children under five, tracking their growth, and providing tailored counseling to caregivers to facilitate the child’s health and development. In some cases, a child’s nutritional status or growth trend may indicate the need for referral to other health services.

Countries have faced many challenges implementing GMP, including inaccurate growth measurements, incomplete or inaccurate reporting, too much focus on nutritional status on the day of the visit rather than on the growth trend, and counseling that is not tailored to the child’s conditions and the caregiver’s circumstances. At a 2018 global convening, practitioners began strategizing how to strengthen the platform and developed a set of recommendations for the way forward.

For the past several years, USAID Advancing Nutrition has been learning about low- and middle- income countries’ experiences with GMP and identifying opportunities to strengthen these services. We developed case studies on common practices, challenges, and opportunities to strengthen GMP in Ghana and Nepal. We have also been exploring how digital tools might help improve the quality of GMP services.

The Role of Digital Tools in Improving Service Delivery

As USAID’s Vision for Action in Digital Health 2020–2024 notes, more and more governments are recognizing the potential for digital health to help the people access the information and services needed to improve their health. Digital tools can provide health workers with instructions and reminders, guiding them through service delivery and decision-making.?

A digital tool for GMP could help countries and health workers address many of the challenges they face when implementing GMP. It has the potential to—

• improve the accuracy of nutrition assessment by guiding health workers in appropriate techniques, identifying improbable measurements, and calculating z-scores?
• increase the focus on growth (and improve interpretation of it) by plotting trends from multiple visits
• tailor counseling to circumstances with reminders about concerns, lists of appropriate counseling topics, and even links to digital resources
• flag children with severe malnutrition to refer them for the appropriate treatment
• integrate updates in policies and guidelines to ensure health workers follow them.

A Guidance Package to Operationalize Guidelines for GMP

USAID Advancing Nutrition’s recently published Guidance Package for Developing Digital Tracking and Decision-Support Tools for GMP Services aims to help countries operationalize global and national guidelines for GMP service delivery and develop a digital tool that is consistent with those guidelines.

The Guidance Package simplifies the development process for health/nutrition program managers and software development teams. It provides a set of documents required for developing a digital tool with the goal of saving time for end users; reducing the duplication of effort, errors, and inconsistencies; and ensuring adherence to guidelines. Implementers will need to adapt the generic, reusable content to national and local contexts, including their health information systems.?

The Guidance Package has six components:

1. an overview of globally-recognized recommendations for GMP service delivery
2. descriptions of who might use the package so that developers can tailor the tools to their roles, responsibilities, and challenges
3. sets of activities and tasks (business processes) and visual depictions of the process (workflows) for delivering and supervising GMP services
4. data elements and indicators that prompt specific follow-up actions
5. decision-support logic that guides health workers based on the data they input
6. suggestions for how to use data to support monitoring, reporting, and supervision.

Deciding to use the Guidance Package is the first step for those interested in using technology to improve GMP service delivery and supervision. In collaboration with the Nepal Ministry of Health and Population, USAID Advancing Nutrition held a workshop in April to take the next step, introducing key stakeholders to the Guidance Package and explaining how to use it. Participants proposed adaptations to the Guidance Package to develop tools that align it with Nepal’s existing GMP guidelines and workflows. The process Nepal followed can serve as an example for other countries.

From Improved Service Delivery to Better Nutrition

USAID Advancing Nutrition’s Guidance Package can assist implementers in developing digital tools to improve the quality and supervision of GMP services. By adapting the contents of the Guidance Package, implementers can design a tool that is interoperable with their country’s health information system. The development and use of such a digital tool could be a worthwhile investment for helping GMP reach its potential to prevent malnutrition—and helping young children reach their cognitive and physical potential, too.

Interested in learning more? Join us on Wednesday, August 30, for our virtual webinar, "Standardizing Content for Digital Tracking and Decision-Support Tools to Improve Growth Monitoring and Promotion Services."