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Charting a Path to Better Nutrition in Ghana

Community Health Workers Master a Critical Skill for Improved Nutrition Counseling

A heath worker plots a child's growth on a chart.
Habiba Alhassan, community health officer in charge of Kugasheigu community-based health planning and services, plots a child’s growth chart.

The Importance of Accurate Tracking

Tracking and monitoring a child’s weight-for-age using a child health record is essential to ensuring that growth and development targets are met, in line with UNICEF and World Health Organization (WHO) standards. At child welfare clinics managed by the Ghana Health Service (GHS), community health workers weigh children from birth to age 5, plotting those measurements against each child’s age in a growth chart to help detect malnutrition. When a child is diagnosed as malnourished, his or her caregiver is referred to a health worker for counseling.

However, this system is only effective when growth is tracked accurately. In 2015, SPRING/Ghana pinpointed inaccurate and incomplete records as a weakness of community-based health planning and services (CHPS) facilities in northern Ghana.

SPRING found that community health care workers and community volunteers sometimes inaccurately recorded child growth, hindering opportunities to identify cases of malnutrition and making it harder to efficiently target counseling or treatment. This led to increases in staff workload, delays in service delivery, and increased the time children and caregivers spent at health facilities.

Opportunities for Improvement

SPRING worked to correct this problem in Garu-Tempane District by providing instruction in proper growth charting to more than 100 health staff as part of its community infant and young child feeding (C-IYCF) training. The course taught staff how to counsel mothers and caregivers and trained community health volunteers to support caregivers in C-IYCF activities in the community, including through growth charting.

 I now understand that completing growth charts correctly is critical to a child’s healthy growth as a result of the C-IYCF training and the continuous monthly coaching visits by facilitators supported by SPRING/Ghana.
—Habiba Alhassan, Community Health Officer, Garu District

Habiba Alhassan, a community health officer at the Kugasheigu CHPS facility who participated in the training, described its impact: “Although I checked the weight of children and filled in their health records since 2011, I did not fully understand its role in monitoring the growth of a child. I used to do it as part of my daily tasks, but thanks to the community infant and young child feeding training and coaching program, I gained a better understanding and enhanced my skills in filling out the child health records.”

Striving for 100 Percent

Since completing the training, Habiba has improved her growth chart documentation skills. During a series of follow-up visits, C-IYCF facilitators reviewed a sample of 20 growth charts that Habiba completed each month at her health facility. Initially, she correctly and completely filled out 12 out of 20 growth charts, but her performance steadily improved to reach 100 percent accuracy.

“As a result of the C-IYCF training and the monthly coaching visits by C-IYCF facilitators, I now know that completing growth charts correctly is critical to a child’s healthy development,” Habiba said. “It tells you whether the child is growing well or not, and I can take the appropriate action to address the situation. Before the training, none of the growth charts in my facility were filled out completely or correctly, but this is now a thing of the past.”

Habiba is now one of the key trainers in C-IYCF for community health volunteers and mother-to-mother support groups in Garu-Tempane District. Her trained colleagues and community volunteers are filling growth cards correctly and completely, as observed during supervisory visits by GHS district staff and SPRING.

Since 2015, SPRING has assisted GHS in its effort to scale up C-IYCF by training 1,528 health workers and 481 community health volunteers in SPRING’s 15 target districts. Recognizing that a single training session does not guarantee mastery of new skills, SPRING helped GHS redefine its approach to supportive supervision and provided tools for on-the-job problem-solving to reduce service delivery bottlenecks.