Optimizing Community-Health-Worker Resources to Scale Promising Child Nutrition Programs in Rural Pakistan

Project Duration: 2022 to 2025

There is evidence that growth posters installed inside the household can improve nutritional outcomes of children by increasing salience, changing the parents’ reference for healthy norms, and helping them better understand the returns to improved nutritional inputs. We intend to test the efficacy of home-based growth monitoring (HBGM) whereby a growth-poster installed inside the home enables caregivers/parents – with front-loaded Lady Health Worker’s support – to measure their children’s height/weight and track their linear growth over time at home (as well as compare this development to the healthy norm as per the WHO 2007 growth standards). An intervention based on home-based growth monitoring has the advantage of being cost-effective and is therefore, scalable.

Our intervention design also attempts to address concerns around intra-household reallocation (for instance, from daughters to sons) in two ways. The poster will have visuals highlighting the benefits of good nutrition to both boys and girls. The counselling will emphasize that there is no difference in nutritional needs between the two genders. Moreover, a key objective of the counselling is to help the caregivers understand the returns to food of better quality (e.g., eggs vs packaged foods/snacks that may cost the same), which should benefit all children in the household irrespective of gender.

The major goal of this project is to test how community health worker resources can be optimized to scale promising child nutrition programs in Pakistan. In terms of research, the results of this cRCT will inform the following question:

Does in-home growth monitoring by caregivers using GroMoTo with active assistance and counseling by a CHW, improve child anthropometrics (as compared to standard nutritional counseling alone)?

Moreover, the project team will carry out a cost-effectiveness analysis in order to compare it to current practices in the field.

Project location: Tando Muhammad Khan, Sindh, Pakistan