LHW Punjab and ICT Report - Oxford Policy Management

LADY HEALTH WORKER EVALUATION – PUNJAB AND ICT SURVEY REPORTPERFORMANCE OF LADY HEALTH WORKERS IN SERVICE DELIVERYWe have developed a performance measure of LHW service delivery using a selection of tenpreventive services. 13 These cover LHW activities in, hygiene, health education, vaccinationpromotion, family planning, pregnancy and birth, child nutrition and growth monitoring.Using our measure of performance we find major differences in the levels of service deliveryamongst LHWs. The top 25 percent - the High Performers provide significantly moreservices than the bottom 25 percent- the Poor Performers. In between we have the GoodPerformers and those who are Below Average.Figure 3-1 Lady Health Worker Provision of Service by Performance Category% target population provided services100908070605040302010017Poor Performers35Below AveragePerformers4868Good Performers High PerformersOn our performance measure the Poor Performers are on average only providingservices to seventeen percent of their eligible clients as compared to the High Performers whoprovide on average services to sixty-eight percent (Figure 3-1). It is easy to distinguish PoorPerformers because they fail to deliver across the whole range of services whereas HighPerformers cover at least sixty percent of clients 14 - and often well above this - for allservices, except growth monitoring. 15 High Performing LHWs are also working longer hours.In the week preceding the survey they had worked over twenty-two hours compared toseventeen for poor performers.In Punjab and ICT twenty-three percent of LHWs are in the high performing categoryand twenty-two percent are Poor Performers (Figure 3-2). The challenge for the LHWPmanagers is to improve the performance of the fifty- percent of Poor and Below AveragePerformers.13 See Appendix 4 and the Quantitative Survey Report for a description of the performance measure of LHW servicedelivery.14 See Appendix 5 for more information on different levels of performance amongst Lady Health Workers.15 The low level of growth monitoring even in the relatively high performing LHWs suggests that there are specificproblems that need to be addressed if the Programme considers it important to offer this service.12