LHW Punjab and ICT Report - Oxford Policy Management

compared to twenty-five percent in each category nation-wide. The Programme needs towork with the Poor Performers to substantially increase their level of service delivery.Thirteen percent of LHWs in Punjab and ICT have additional paid work. This doesnot however cause poor performance as we have found that High Performers are more likelyto have a second job than Poor Performers.The Knowledge TestThe Evaluation Team developed a Knowledge Test based on the LHW manual. LHWs whowere High Performers in service provision tended to get better test results. In addition, wefound that the higher the education of the LHW and the Lady Health Supervisor (LHS), thehigher the score. This means that it is important the Programme does not lower its educationcriteria if it wants to maintain performance.Across the country, the knowledge of the LHW and their Supervisors is high in manyareas. LHSs in AJK and FANA score the highest in the country on the Knowledge Test withan average score of seventy-seven percent. On average LHWs in Punjab and ICT scoreseventy-percent compared the national average of sixty-nine percent.The low scores and lack of in-depth knowledge of a minority of LHWs could haveserious clinical consequences as well as undermining the professional reputation of theProgramme. The Programme needs to ensure an on-going system of knowledge assessmentand reinforcement for all LHWs.Organisational Support- Supervision, Pay and SuppliesOn average, Supervisors in Punjab and ICT manage twenty-eight LHWs. Five percent ofLHWs in Punjab and ICT do not currently have a Supervisor. The majority of LHWs inPunjab and ICT had received at least one visit from their supervisor in the past month andhad attended a monthly meeting at the health facility in the past two months. On average, inthe previous month Supervisors in Punjab and ICT had worked twenty-three days. Howeverinsufficient access to vehicles and lack of sufficient POL allowance is hindering fieldsupervision. Only sixty-seven percent of LHSs in Punjab and ICT reported having full-timeor partial access to a LHWP vehicle in the month preceding the survey. LHSs who did nothave vehicles did use public transport but this is not a perfect substitute for vehicle access.Lady Health Workers and their supervisors should receive their pay monthly. InPunjab and ICT only thirty-five percent of LHWs had received their pay in the past twomonths and forty-two percent had not been paid in over three months. The results are similarfor Supervisors. The pay system at the time of the survey was not working well.Medical supplies and equipment are essential in ensuring an effective communityhealth service. Also the credibility of an LHW amongst her community will also beundermined if she is unable to distribute contraceptives and other medicines as expected.Numerous medicines had not been available for the Punjabi and ICT Lady Health Worker’smedicine kit during the previous three months. Supplies are not arriving at the healthfacilities for distribution. This problem has a number of causes including distribution fromProvincial stores and insufficient supplies being purchased by the FPIU. In Punjab and ICT,nine percent of the Lady Health Workers did not have a LHW manual, which is an importantviii