Health facilities readiness and associated factors to provide growth monitoring services in low-income and middle-income countries: evidence from national service provision assessment surveys of six countries.

Abstract

Malnutrition among under-5 children is a major challenge in low-income and middle-income countries, contributing to poor growth and development. Growth monitoring and promotion (GMP) is recommended by WHO for early detection, yet its implementation remains weak due to limited resources and health system gaps. While many studies focus on utilisation, little is known about facility readiness, especially from multicountry analyses. This study aimed to assess the readiness of health facilities to provide growth monitoring (GM) service and associated factors using nationally representative data. Secondary analysis of existing cross-sectional survey data. Secondary data from service provision assessment surveys of Afghanistan, Bangladesh, Ethiopia, Haiti, Nepal and Tanzania was used. We included 6595 health facilities, which have complete information. Health facilities' readiness score was constructed as a counting score with regard to the availability of essential indicators required to provide GM services by using WHO service availability and readiness assessment. Among 6595 health facilities, 28.5% (95% CI 27.4% to 29.6%) of the facilities reported at least 75% of the relevant items for GM service provision. The factors associated with health facilities' readiness to provide GM service were quality assurance activities (incident rate ratio (IRR): 1.15; 95% CI 1.07 to 1.24), separate user fees (IRR: 1.10; 95% CI 1.00 to 1.20), fixed user fees (IRR: 1.20; 95% CI 1.10 to 1.31) and presence of trained health provider at facility 24 hours (IRR: 1.09; 95% CI 1.02 to 1.17). Health facilities in six countries showed low readiness for GMP services. Strengthening facility capacity, staffing, equipment and quality assurance is essential to improve readiness.