Rethinking Growth Monitoring and Promotion in the Era of Universal Health Coverage: Qualitative Assessment of Programme Delivery Challenges in Ethiopia.

Abstract

Growth monitoring and promotion (GMP) programmes have been implemented for decades in almost all countries. Despite this long history of implementation, GMP has been criticised for being ineffective, calling for a rethink of the programme. With a view of contributing evidence towards the redesign of GMP, we conducted a qualitative evaluation of the programme in various contexts of Ethiopia. We conducted focus-group discussions (FGDs; n = 28) and key informant interviews (KIIs; n = 193) with programme managers, service providers and caregivers beneficiaries. Supply-side, service delivery, and barriers hindering effective coverage were identified. Lack of functional weighing scales, budget constraints, limited transportation facilities, overlap of interventions, and the low motivation and performance of health workers were identified as main barriers affecting the quality-of-service delivery. The benefits of participating in GMP were not always clear to beneficiaries. Competing priorities like household chores, long travel distances to health centres, and in some contexts culturally insensitive practices deterred participation. Although GMP can serve as an entry point for mainstreaming nutrition into universal health coverage (UHC), the programme would need to be redesigned and supported by adequate supply, resources (financial and human), planning, and quality service delivery that is contextual and culturally sensitive.