LHW Systems Review - Oxford Policy Management

LHWP – Systems ReviewChange/addition tocurriculumIn 2006, the LHWPrevised the whole MISmanual andincorporated thechange into the BasicCurriculum of LHWsand LHSs (2007).Change mechanism:response from the trainingdivision on what stimulatedthe revisionRevision of the MIS wasbased on the changes in theLHS/LHW curriculum.Additional indicators wereadded, based on the LHWmanual (e.g. number ofantenatal visits, registerednumber of pregnant women,children aged 0–35 months,maternal mortality ratio, etc).LHWs were involved in TBDots. The indicator for thisactivity was introduced.Indicators of Initiation of BF,SBA, and the number of ANCvisits were also included.The denominator of tetanustoxoid vaccination, the numberof ANC visits denominator waschanged from all pregnantwomen to all womendelivered.Non-drug items (e.g. weighingmachines, torches, etc.) hadnot previously been recordedin the MIS. They wereintroduced to recordavailability and functionality.Was therepiloting?No pilotingHow and whenwas the changeimplementednationwide?New recruit in theLHWP receivetraining onrevised manual.All workingLHWs receivedthe refreshertraining. NewLHSs receivedtraining on therevised manual.All working LHSshave 12 days’mandatoryrefresher trainingon the new MISmodule for LHSincorporated inthe BasicCurriculum 2007.Four days’training onrevisedcurriculum in2007, and againin 2008 and 09.Is it integratedinto thesupervision/inspectionmechanisms?YesRefresher training was given greater emphasis after the 3rd Evaluation, and included as a requirement inthe PC-1Counselling cardsYesChild Survival andChild Health Modulebased on CommunityIMNCI (initiatives byUNICEF and WHO).Nutrition manualThis initiative was based onthe findings of 3rd Evaluation,where weak counselling skillswere identified.The LHWP felt the need toprovide job support to theLHWs to help them incounselling.The 3rd Evaluation of theLHWP suggested that the useof charts was insufficient, andit was suggested that a tool beintroduced.UNFPA introduced theintervention at LHW level, asthe IMNCI skills were presentat the first-level health facility,but not at LHW level, so it waspiloted at LHW level.The National Nutrition SurveyReport suggested thatnutrition is an important andcross-cutting issue; however,the indicators were not good,which is why this training wasPiloted in2003/04 inSave theChildrendistricts,followed byUNICEF andUNFPAdistricts.Replicated in2005/06throughoutthe country.Piloted byUNFPA andUNICEF in2004/05.Replicated in2005–08.No pilot.Training ofLHWsconducted in2005.YesIt was alreadycovered insupervisorychecklist.80