LHW Management Review - Oxford Policy Management

LHWP – Management Review
• The government and the managers of the Implementation Units know the
procedures, policies and standards of the Programme even if at times there is a lack
of authority to enforce compliance and to deliver sanctions for non-compliance. One
solution to this weakness is the functioning of oversight committees of senior people
who have influence to promote the benefits of compliance to support the resolution of
difficult problems. Another is for senior management to be able to deliver more
effective sanctions to non-compliant districts and provinces.
• The Programme did not pilot different models for Programme operation in different
districts, as it had planned to do after 2005.
• Different service delivery models implemented by the provincial or district
governments can have an impact on the integration of the Programme as an
outreach service delivering public health services. For example, the contracting out of
Basic Health Units. It is important that different service delivery models allow for the
benefits of integration to be retained.
4. How well has the LHWP been integrated with other Public Health Programmes?
• Federally funded primary health care programmes are designed to address issues
that are of national priority. It is not possible to implement these programmes without
the collaboration of the provincial Departments of Health and the district Health
Offices.
• It is reportedly difficult to achieve policy coordination amongst the MoH’s public
health programmes. The PC-1 planning process, which essentially locks in activities,
does not support collaboration and inhibits flexibility and responsiveness. In addition,
Programme manager report spending a lot of their management time attempting to
get permission from higher authorities for initiatives that appear to be already within
the framework and intent of the PC-1.
• Coordinating public health services at the district level is the responsibility of the
EDO-H: the day-to-day operation of the public health programmes is managed by his
management team members, with whom he holds regular meetings. If there is a
District Health Plan, then the LHWP is typically included in it and the District
Assembly will have reviewed the plan.
• The EDO-H reported that the LHWP fit best with district health priorities of mother
and child health care, family planning and National Immunisation Days (NIDs).
Across the country there was consensus between District Coordinators (DCs), LHWs
and LHWs that the Programme’s top priority was maternal health, child health and
family planning.
• LHWs are spending a significant amount of time on NIDs in collaboration with the EPI
programme. This activity is the result of commitments made by the government to the
World Health Organisation to participate in the international goal of polio eradication.
Working on NIDs does not have a negative impact on the LHW’s performance
however nearly half of all LHWs are working outside their catchment area on this
activity, which is against Programme policy. The high commitment in time required by
LHW for NIDs needs to be monitored to ensure that other core priorities are not
displaced.
• The EDO-H and his DC of the Programme manage the LHWP. Many of the EDO-Hs
attend, even if briefly, the monthly LHS meetings chaired by the DC.
• There will always be a tension between the prescribed solutions that address
National Health Priorities and the need to have some flexibility in service delivery to
cater for district priorities. However there appears to be consensus between the
district health management and the LHS and LHWs that the focus on service delivery
should be on maternal and child health and family planning. While district managers
would like an increase in budget allocation and salary incentives, there does not
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