LHW Management Review - Oxford Policy Management
LHW Management Review - Oxford Policy Management
LHW Management Review - Oxford Policy Management
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<strong>LHW</strong>P – <strong>Management</strong> <strong>Review</strong><br />
• Do the management controls of the Programme support the implementation of the<br />
Strategic Plan and the PC-1?<br />
• How has innovation and quality improvement been managed?<br />
• What have been the benefits and tensions of expansion from 37,000 <strong>LHW</strong> to 90,000<br />
<strong>LHW</strong>s?<br />
• Has expansion led to greater coverage in remote areas and to poorer families? And,<br />
if not, what are the issues?<br />
• How well has the Programme been implemented across different levels of<br />
government?<br />
• How well has the <strong>LHW</strong>P been integrated with other Primary Health Care<br />
Programmes?<br />
• Has the Programme managed to deal effectively with non-performing <strong>LHW</strong>s?<br />
<strong>Management</strong> review findings<br />
The following is a summary of the main findings in response to each of the seven questions<br />
of the management review. They should be read in the context of Chapter 3 of this report<br />
which provides an overall judgement of Programme performance made on the basis of the<br />
findings from the quantitative survey, qualitative studies, the management and systems<br />
reviews and the finance and economic analysis.<br />
1. Do the management controls of the Programme support the implementation of the<br />
Strategic Plan and PC-1?<br />
• While the Programme has nearly 90,000 <strong>LHW</strong>s working in their communities there<br />
has not been full implementation of the directions and key activities of the Strategic<br />
Plan and PC-1. This is attributable to a failure of governance processes and<br />
management control rather than a systems failure.<br />
• There was insufficient strategic control of the Programme, to drive it into the planned<br />
Phase 2 outlined in the PC-1. This was both because of the absence of strategic<br />
review mechanisms (including not holding a mid-term evaluation and not convening<br />
the relevant high-level committees) and the high management turnover.<br />
• The non-functioning of these committees left the programme vulnerable. The<br />
committees if fully functional would have been able to provide decision-making space<br />
for the Programme where important issues could be debated and determined. The<br />
committees would have been in a position to influence the appointment of<br />
experienced and motivated managers in the Implementation Units.<br />
• In addition, the position of National Advisor remained vacant after September 2005.<br />
The purpose of this position had been to support the Programme in coordinating<br />
activities with the provinces in planning and piloting strategies for the future.<br />
• Once Federal Government commitment and funding was assured through the<br />
approval of the PC-1, issues of sustainability and decentralization were clearly no<br />
longer a priority. However, the Programme has to manage for risks of a policy<br />
reversal that could put goals of poverty reduction and health improvement by a<br />
Programme operating at the grass roots at risk. For example, social sector<br />
investments being routed through provincial government and district government<br />
Annual Development Plans.<br />
• To guarantee the provision <strong>LHW</strong> services there will always need to be some financial<br />
commitment from the federal government with a requirement for performance and<br />
adherence to the Programme’s performance and quality standards. The Programme<br />
needs to increase its accountability. Annual reporting against key performance<br />
indicators has been weak or non-existent.<br />
iv
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