LHW Systems Review - Oxford Policy Management

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LHWP – Systems ReviewJob title Main role Accountable toProvincialCoordinatorProject MonitoringSpecialist (4positions)Federal MonitoringUnit (4 officers)FPIU AccountantFPIU DeputyCoordinators (2positions)FPIU: NationalCoordinatorFederal-levelTrainersProvincial-levelTrainers, Doctors/ParamedicsDistrict levelTrainers, Doctors/ParamedicsFLCF-levelTrainers, Doctors,LHV, TechnicianSource: LHWP, MoH.e.g. Balochistan –District Health OfficerMonitoring systems:DPIU to CommunitylevelAnalyse monitoringreports; conduct fieldvisitsProgrammemanagementDG Health,accountable to FPIUfor ProgrammeresponsibilitiesFPIU/UNFPAPayment fromProgramme fundsProject allowanceUNFPA (withdrawn inthe financial year2000/01).EmploymentstatusPublic servanton deputation(Punjab is theonly provincewhere this is afull-timeposition.)1-yearcontractFPIU UNICEF 1-yearcontractNational ProgrammeManagementNational ProgrammeManagerProject allowanceProgrammemanagementDG Ministry ofHealthProject allowanceTraining FPIU 20% allowance whiletrainingTraining PPIU 20% allowance whiletrainingTraining FLCF trainers DPIU for training 20% allowance whiletraining, but not ifalready working forDPIUTraining LHWs DPIU for training 20% allowance whiletrainingPublic servanton deputationPublic servanton deputationPublic servantPublic servantPublic servantPublic servantPublic servant84
AnnexesAnnex C MIS and the measurement of results against KPIsCore to the purpose of the MIS is the provision of information that allows for themeasurement of results against the KPIs. Is the MIS designed to provide measurement ofthe KPIs? The indicators in the PC-1 and the Strategic Plan are provided in Tables C.1–C.4. 89 For each indicator, there is a column that indicates whether or not the MIS providesthis information.Key performance indicators (KPIs) Both the PC-1 and the Strategic Plan (which isincluded as an annex of the PC-1) define the key indicators that are to be monitored.Strategic Plan KPIs The Strategic Plan identified four key areas to be managed by theProgramme, together with the strategies and actions to be taken: expansion of coverage tounderserved and poor areas (Table C.1); improving quality (Table C.2); expanding the scopeand mix of services of the LHWs (Table C.3); and improving performance monitoring andevaluation for evidence-based Programme design and management (Table C.4).In each area, a set of key performance indicators was developed. Measures of theseindicators would be provided from a range of sources, including: PIHS Survey, Programmepayroll, Programme monitoring and evaluation systems, and external evaluations.PC-1 input/process indicatorsThe Programme also had a list of input or process indicators identified in the PC-1 (TableC.5). To identify targets for these, it is necessary to research the rest of the PC-1 and theStrategic Plan. 90 The input indicators can be classified as either measures of populationcovered by services (the first goal of the PC-1); measures of the tools that are used to collectinformation on Programme performance, including outputs and outcomes; and measures ofinputs under the Programme’s control that were shown by the previous evaluation toincrease LHW performance: supervision and LHW knowledge.PC-1 output/outcome indicatorsThe Programme set itself the task of contributing to a number of important national healthoutcomes, listed in the PC-1 (objectives and targets, Table C.6). 91 While the Programmecannot be held directly accountable for these objectives and targets, the link between LHWservices and improvements in indicators was demonstrated in the 3rd Evaluation (e.g. CPR,EPI). 92 The assumption is that high-performing LHWs will make a difference to healthoutcomes. The PC-1 provides output/outcome indicators (Table C.6, column 3) that it willaim to achieve in order to contribute to the national health outcomes.89The PC-1 is the operational plan for the LHWP. It is instrumental in gaining access to resources translated into the annualCash/Work Plan, which is the budget request to the Ministry of Finance. The input for the Cash/Work Plan is provided by thePPIU to the FPIU after consultation with the DPIUs. It is time-bound by the requirements of the Planning Division and theMinistry of Finance.90The Strategic Plan (2003–11) is an annex of the PC-1 (2003–08).91Alignment with Health Policy Most of the objectives and targets for the LHWP are aligned with the National Health Policy,2001. In this policy, targets for 2010 were set at: IMR 55 per 1,000 live births; MMR was 180 per 100,000 live births; CPR was50 percent of the total population; EPI at 100 percent coverage (higher than the LHWP targets); and 100 percent coverage bythe LHW of the target population.92The concept of contribution needs to be stressed here because, in some of the interviews conducted for this evaluation, itwas apparent that the complexity of improving these outcomes was not fully understood: some officials thought that theProgramme was the key initiative responsible for improving the primary health indicators.85
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AcknowledgementsThis evaluation of
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RPIURs.SCF-UKSCF-USSNIDsSoEsTAMATB-
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Training system5 Training system5.1
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