A study of the implementation of a facility-based growth monitoring programme: the Nairobi City councll
This study was conducted to assess the implementation of the growth monitoring programme in the City Council health facilities. This was to determine whether the physical and structural components necessary to implement the programme were in place. Nine out of 38 health facilities were randomly selected for inclusion into the study. This selection ensured that a facility was selected from each of the selected divisions, and that the three main types of health facilities were represented. From these nine facilities, the attitudes of nine health administrators towards the programme were determined as well as the knowledge and technical abilities of eighteen health workers in carrying out the programme. This was done using questionnaires that had been previously pre-tested. Using questionnaires. existing records and through observation. an assessment was done on the adequacy of supplies in the facilities and the accuracy and condition of weighing scales was determined. In addition. three hundred and eighty four programme users (the mothers) were randomly selected and interviewed on their attitudes towards the programme. Suggestions were also drawn on how they thought the programme could be improved. The findings indicate that the availability of physical and structural components necessary to implement the programme efficiently were inadequate. This was quoted as the biggest constraint by those who implemented the programme. Out of the nine facilities. eight of them had a shortage of the child health cards and four of them did not have follow-up registers, tally sheets and reference booklets. The health workers did not take correct weights of the children because they did not adjust the scale to zero for every child. During counselling, some of the health workers did not brief the mothers on their babies' weight progress. Despite these shortcomings, it was surpnsmg that most of the mothers (78 %) were satisfied with the programme and the employed mothers created time to take their children for growth monitoring. There was a significant difference between the mothers who were satisfied with the programme as compared to those who were not, in that the satisfied mothers: had received nutrition education from the facility (p <0.05), reported a good rapport with the health workers (p <0.05), did not feel that the programme interfered with their daily activities (p <0.05), and gave suggestions as to how the programme could be improved (p < O.05). Most mothers suggested that for improvement of the programme. the health workers should give them nutrition/health education every morning prior to the growth monitoring sessions. The study led to the conclusion that the implementation of the growth monitoring programme in Nairobi's health facilities is inadequate. It is therefore recommended that the Government and other Donor Agencies interested in the effective implementation of the programme should supply the programme with the minimum supplies and resources needed to implement it. For sustainability, it is recommended that the health administrators should charge the mothers a small fee for each GM session attended, so that the money generated can be used to maintain the machines and to photocopy the child health cards when they run out of stock.