LHW Management Review - Oxford Policy Management

LHWP – Management Review
Table 5.2
Plan for managing the development of the scope and mix of
services provided by the LHW
Process
1 Produce a clear statement of priorities in extending the scope of the LHW work that would utilise her
time and capabilities effectively. The statement would reflect: clinical priorities for achieving reductions
in mortality and increases in family planning choices; therapies that have proven clinical efficacy; can
be safely administered by the LHW; are low-cost; reflect the workload, motivation and remuneration of
the LHW; and,
Capabilities of Programme systems to support the training and delivery of new therapies.
2 Development of a strategy for expansion of the scope of the LHW’s services based on the statement.
3 Provide review guidelines for the process of the selection of new activities.
4 Provide review guidelines for the implementation of provincial- and district-level initiatives that expand
the clinical scope of the LHW’s activities.
5 Advise the provinces and districts of the guidelines.
Source: Strategic Plan (2003–11), LHWP, MoH.
Review of process for increasing the range of services As has been mentioned
previously, the Programme Review Committee never met during the five year under review.
A committee was formed in 2006, the Technical Committee of Innovations (TCI), which had
the aim of evaluating proposals for new initiatives. It is unclear whether this was to replace
the originally planned internal management committee referred to in the PC-1 that was to be
chaired by the National Coordinator and included the National Advisor, Deputy National
Coordinator, and two Provincial Coordinators. The TCI membership included development
partners and external stakeholders. By 2008, the TCI had met four times. However, some
members/participants thought the Committee had unclear terms of reference and lacked a
mandate to make decisions.
Neither the internal management committee nor the TCI carried out the important task of
establishing the statement of priorities that would provide the criteria for making judgements
on the LHW’s scope of work.
5.4 Use of pilots and refresher training
The discussion that follows focuses on the Programme’s use of pilots and training as their
approach to increasing the range of services provided by the LHW, and in developing her
professional competence in service delivery. 37
Pilot studies and trainings are of particular interest, as they are often funded by development
partners in partnership with the Programme. Pilots are inexpensive for the Programme but
are, reportedly, very time-consuming of management attention. Pilots might distract from
initiatives already in the PC-1 that were intended to expand the scope of LHW services and
that were not fully implemented – for example, the EPI policy (approved in 2001/02), and the
plan to provide opportunities for LHWs to observe child deliveries in different settings. 38
37
The scope of work of the LHWs is described in the PC-1: p. 33.
38
This was to be a part of the Training on Safe Motherhood. The results of this evaluation show it is still unusual for the LHW to
be present at the birth: LHW presence at a birth is Programme policy.
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