Study of the grade system (sistem nilai) : a new development in child growth monitoring techniques

Special evaluation is based on interviews and tests with sample beneficiaries and CRS counterpart personnel at 10 maternal/child health (MCH) centers at which the grading system is being pilot-tested. CRS has been experimenting with the grading system for about 2 years. The system was devised as a way of translating key growth indicators (age, weight) into a single number on a scale from 1 to 10 that would serve as an indicator of growth status. The grading system was found to be easily understood and used by both MCH workers and mothers, a major breakthrough given longstanding problems with the unintelligibility of the health progress card (the standard growth monitoring instrument in Indonesia). Part of this success is due to the similarity between the growth status grade and the system of school grading, since acceptable health grades (roughly from 7 to 10) are similar to acceptable school grades. Further, 93% of parents were able to easily recall their child"s current health grade, and about half could remember their child"s grade 6 months ago. Parents were able to do this regardless of economic status and, to a large extent, educational level. Fully two-thirds of the illterate mothers in the sample showed full comprehension of the system. Though unsystematic and anecdotal in nature, evidence also suggests that the system may be increasing demand for health services, since a low grade serves as a "symptom" of health problems to parents. Grading accuracy, despite some confusion on the part of MCH workers about whether to round figures up or down, was found to be high. In addition to being an accurate measure of individual children"s growth, the grade system also provides valuable data for monitoring program operations. However, grade data should not be used to monitor the program"s impact on community unless inter- and intra-community control groups have been previously established. Recommendations are to: replicate the grade system in as many CRS counterpart centers as possible; use the parallel between growth and school grades more extensively in training MCH workers and in consulting with parents; develop a simple training packet in order to expand the range of people who can calculate grades; and seek ways of using the grades to more effectively monitor individual child growth.