LHW Management Review - Oxford Policy Management

Programme description
Management information The management information systems of the Programme, both
formal and informal, provide the information necessary for operational management and
reporting requirements. Management information is provided by internal administrative
systems and by independent external evaluations. The external evaluations provide
information on the systems’ performance, quality of inputs, service delivery and outcomes.
Risks In the beginning, the main risk was that communities would not allow LHWs to provide
their services. As the Programme became established, this risk diminished and, at the time
of the 3rd Evaluation in 2000, the risk was, rather, that funding would be discontinued and
that myths about the Programme would destroy a fragile reputation. Now, in 2009, the
Programme has established itself as an important institution in delivering primary health care
services at the community level. Of greater risk now is that the Programme might not have
the level of control over LHW service delivery that is required to ensure improved health
outcomes. Another risk is that the Programme becomes entrenched in its current mode of
delivery, and lacks the management control and leadership necessary to ensure its ongoing
development as envisaged in the Strategic Plan.
2.2 Planned achievements, 2003–08
2.2.1 The 3rd Evaluation, the Strategic Plan and the PC-1
The LHWP is a development project managed by the MoH (federal government of Pakistan)
in collaboration with the provincial Departments of Health. It has a Strategic Plan (2003–11)
that outlines the medium-term direction for the Programme under the umbrella of the
government’s strategic objectives. These include the Poverty Reduction Strategy Paper
(PRSP) and the National Health Policy.
3rd Evaluation In 2002, the 3rd Evaluation of the Programme had been completed and the
Strategic Plan for 2003 to 2011 was being developed. The reputation of the Programme had
been significantly enhanced by the 3rd Evaluation as, prior to those results, there had been
scepticism in some quarters as to whether the Programme was actually functioning at all.
The evaluation had shown that the Programme was having an impact on health outcomes,
and that personnel were complying with many of the operational standards. However, the
Programme was under-performing due to lack of funding and a low level of performance by
around one quarter of the LHWs. 14
Strategic Plan The Strategic Plan was developed on the basis of extensive consultation in
order to cover the years 2003 to 2011. It forms the basis for the PC-1, and is included as an
Annex. It is not a component of the development budgeting system.
The Strategic Plan is described as ‘providing a vision and a direction for the future of the
Programme’. Its focus is on how to improve ‘the quality of the services delivered by the LHW
and ensuring that these services are reaching the rural poor’. 15
The Strategic Plan defined the Programme’s key objectives as:
• improving the quality of services provided by the Programme by addressing the
weaknesses recently identified in by the 3rd Evaluation; and
• expanding the coverage of the Programme from approximately 40,000 communities
in the late 1990s to approximately 100,000. 16
14
The sheer size of the Programme with its proven impact on health indicators make it unique internationally.
15
Strategic Plan: p. 3.
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