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In: Growth Promotion for Child Development. Proceedings of a colloquium held in Nyeri, Kenya, 12-13 May 1992, edited by J. Cervinskas, N.M. Gerein, and Sabu George. Ottawa, Canada, International Development Research Centre [IDRC], 1993 Feb. 33-42.UNICEF has been a vocal advocate of the widespread application of growth monitoring and promotion (GMP) for 10 years. The UNICEF Evaluation Office is an office within UNICEF responsible for conducting global thematic evaluations of a wide range of UNICEF activities. Evaluations involve reviewing literature, drafting terms of reference for evaluating activities in selected countries, and reviewing findings leading to policy changes for UNICEF at the global level. This paper describes progress made in conducting evaluations of GMP efforts coordinated together with UNICEF's Senior Nutrition Advisor. Data were collected for 1990-91 through focus groups and interviews in China, Ecuador, Indonesia, Malawi, Thailand, Zaire, Zambia and subsequently analyzed. A summary is presented of actions reported to have been stimulated by the assessment and analysis of anthropometric data at household and community levels and constraints to actions identified. The following lessons learned were agreed upon during a review meeting: resources are short for GMP; programs should be implemented only where there is demand; GMP should no longer be promoted as an entry point to improve the health system or other sectors; existing, poorly done GMP programs waste resources and incur large opportunity costs; promoting growth for child development is important especially where growth faltering is prevalent; program management may take several forms; inabilities to analyze and respond are primary constraints to good GMP in most country programs; GMP can promote empowerment where the context allows; and GM data should not be analyzed under the auspices of the health sector in order to avoid bias.
World Development. 1982; 10(7):573-84.Current efforts at involving communities in health activities are analyzed from a number of perspectives. Participation may be mainly aimed at easing resource constraints, through involvement in the implementation of health activities. Examples are the construction of health infrastructure, or the enlistment of community health workers--though in Latin America strong medical resistance to delegation has severely restricted their tasks. Participation in decision making has been even more limited, with the exception of some small scale NGO (nongovernmental organizations) sponsorship projects with conservative or progressive orientations also differ in degree of participation. The structure of the community, and the sociopolitical context in which it exists, are examined for the different constraints and opportunities they present to community participation for health. (author's modified)