After a year of intensive development and pilot testing, the Government of Bangladesh has added a new module for growth monitoring and promotion (GMP) to its core mobile application-based service delivery platform for frontline workers.

Working under the direction of the Government of Bangladesh, Alive & Thrive provided technical assistance to build the GMP module, which allows health workers and caregivers to monitor a child’s growth over time.

“Using this IT solution, the frontline supervisors and managers can monitor field activity, which would strengthen supportive supervision and ensure strategic use of data for GMP service delivery,” said Gourob Kundu, technical monitor of the initiative and Monitoring, Learning and Evaluation Specialist for Alive & Thrive in Bangladesh. “Scaling up this IT initiative will support ensuring quality GMP service provision and digitalization of health service delivery in Bangladesh.”

The GMP module includes a data dashboard for frontline managers and supervisors that allows them to monitor an individual child’s growth and, at the same time, see the children’s growth status in a particular area. It also facilitates government tracking of population-level growth changes and includes infrastructure for future integration into DHIS2, a software platform that countries use for collecting and analyzing health data.

The GMP module, which went live in August 2022, is the cornerstone of a new Government of Bangladesh campaign to increase health sector efficiency by bundling GMP services with routine immunization platforms. The Government of Bangladesh has long identified GMP as a priority activity in the National Nutrition Services Operational Plan, but faced challenges, including an outdated, paper-based tracking system that made data collection more difficult and prone to error.

The new module provides a one-stop shop for health workers, supervisors and government officials to store, track and analyze individual and population-level child growth data in real time, allowing for more accurate diagnoses and informed policymaking.

The module is more efficient because “I do not need to carry the heavy register book now, as I can register children through this app,” said one health assistant. “Also, the app will reduce the chances of data missing and it will be easy to find any data using the search button.”

The GMP module includes features to support service provision (e.g., digital registration of children, instant diagnosis of severe malnutrition, classification of children by nutritional status, prompting of age-specific nutrition counseling messages), and the ability to engage with caregivers (e.g., sending text messages and voice recordings to caregivers and reminder messages for GMP services). It collects both demographic data - such as the child’s name, date of birth, the names of their parents, and their parents’ economic status - as well as growth monitoring data, including the child’s length, height, weight and mid-upper arm circumference (MUAC).

Through use of this technology, supervisors and managers at multiple levels will have synchronized access to service provision data for better decision making. The module also strengthens the immunization campaign with which the GMP services are bundled by sending reminders for upcoming vaccines.

In order to build the module, Alive & Thrive established a partnership with mPower, a Bangladesh-based technology firm focused on social impact. The partnership allowed Alive & Thrive to pair its technical knowledge of nutrition issues with mPower’s technological capabilities to develop an accessible product that consolidates up-to-date, accurate child nutritional status information. Along with developing the product, mPower helped to install the module on government-provided tablets that the health workers were already using.

The core mobile application-based service delivery platform for frontline workers was developed following the traditional Software Development Life Cycle (SDLC) that involved designing, developing and testing two versions of the app (alpha and beta) and then using feedback they gathered on each version to create the final product. The GMP module was then pilot tested in the field for about two months following a two-day training on the new system for frontline workers and their supervisors.

Following the pilot period, the team collected feedback on the module and used it to further refine and optimize the technology. The Government of Bangladesh is currently conducting final IT adjustments and will roll out the module on a larger scale once their review is complete.

In a follow-up study conducted by Centre for Qualitative Research, an independent research firm, health workers expressed high satisfaction with this new IT solution.

“I found the GMP app very effective,” one health assistant reported. “Once we enter the data, we can easily access children’s nutrition status. We don’t need to write the data again and again.”

Alive & Thrive and the Government of Bangladesh believe the module will not only improve individual service provision, but also drive data-driven decision-making on reducing rates of child malnutrition.