LHW Systems Review - Oxford Policy Management

More documents

Recommendations

Info

LHWP – Systems Review• Over-reliance on the MIS Due to the lack of development of the mini-surveys andthe absence of a mid-term external evaluation, the Programme had to rely on theirMIS for information. The mini-surveys and evaluations were to be important sourcesof performance information and MIS validation. The MIS is reliant on inputs from over95,000 people, many health facilities, and over 130 districts. While it can provideongoing management information, and this is used by some of the active districts andprovinces, it does need to be supported by additional high-quality monitoring andevaluation information; and• Reducing the amount of information collected by the LHW as proposed by theStrategic Plan was not explored.Conclusion• The performance required of the LHWP systems is relatively well specified in theStrategic Plan and the PC-1. Overall, the systems of the LHWP have coped with thelarge expansion of the Programme from 40,000 LHWs in 2000 to almost 90,000LHWs in 2008. The systems have operated to: recruit LHWs and LHSs (althoughthere was a failure to recruit drivers); provide training, including continuing training atthe health facility and refresher training courses; improve the level of supplies toLHWs (although there are still problems); improve the payment of salaries (although,again, there are still unacceptable delays); and increase the level of supervision ofLHWs.• The core design of the systems appears robust, and has been sustained over the 15years of the life of the Programme. Poor systems performance occurs most oftenwhen there is a shortage of inputs, or non-compliance with the systems standards.For example, there was insufficient procurement of supplies for the LHWs (logisticssystem); non-compliance with residency criteria in Sindh (selection and recruitmentsystem); and lack of funds for salary payments was evidenced at the time of theQuantitative Survey.• These problems are management and governance problems, not systems problems.• Three particular areas of non-performance in systems need to be highlighted:o The system for dealing with non-performance of LHWs requires improvement sothat, where there is evidence of non-performance and a non-willingness to work,the LHW can be terminated efficiently;ooThe process for condemnation of vehicles is not operating;The procurement process conducted by the MoH and the FPIU has experiencedproblems resulting in long delays in purchasing.• Systems also need to undergo continuous improvement (not necessarily be radicallychanged), and planned systems developments were generally not implemented. Thiscannot be attributed to lack of funding, as many of the developments did not requireadditional funds; neither can this be due to the tensions of rapid expansion, as mostof the expansion of the Programme had occurred by 2003.• Our conclusion is that there is a lack of management attention focused on systemsimprovements: attention is absorbed by operational concerns. It is also difficult tobuild up the necessary experience to deal with systems development when there arefrequent changes in senior management in the Programme and in the Ministry ofHealth (see also Management Review). There is also a lack of accountability to theMinistry of Health for developments budgeted for and approved in the Strategic Planand PC-1.x
Table of contentsAcknowledgements ................................................................................................................... iExecutive summary ................................................................................................................. iiiList of tables and figures ....................................................................................................... xiiiAbbreviation ........................................................................................................................... xv1 Introduction ..................................................................................................................... 11.1 Background ............................................................................................................. 11.2 Programme performance ........................................................................................ 12 Systems under review ..................................................................................................... 52.1 System description .................................................................................................. 52.2 System performance ............................................................................................... 63 Stakeholder interviews .................................................................................................... 73.1 Systems and reported risks ..................................................................................... 84 Selection and recruitment system ................................................................................... 94.1 Purpose ................................................................................................................... 94.2 Performance measures ........................................................................................... 94.3 In operation ............................................................................................................. 94.4 Planned systems development, 2003–08 ............................................................. 114.5 System performance ............................................................................................. 124.6 Reported causes of non-performance ................................................................... 144.7 Findings ................................................................................................................. 145 Training system ............................................................................................................. 175.1 Purpose ................................................................................................................. 175.2 Performance measures ......................................................................................... 175.3 In operation ........................................................................................................... 175.4 Planned systems development, 2003–08 ............................................................. 215.5 Systems performance ........................................................................................... 215.6 Reported causes of non-performance ................................................................... 255.7 Findings ................................................................................................................. 266 Logistics management system ...................................................................................... 296.1 Purpose ................................................................................................................. 296.2 In operation ........................................................................................................... 296.3 Planned systems development, 2003-08 .............................................................. 336.4 System performance ............................................................................................. 346.5 Reported causes of non-performance ................................................................... 396.6 Findings ................................................................................................................. 407 Salaries and payments system ..................................................................................... 437.1 Purpose ................................................................................................................. 437.2 Performance measures ......................................................................................... 437.3 In operation ........................................................................................................... 437.4 Planned systems development, 2003-08 .............................................................. 457.5 System performance ............................................................................................. 467.6 Reported causes of non-performance ................................................................... 477.7 Findings ................................................................................................................. 48xi
Page 3 and 4: Lady Health Worker ProgrammeExterna
Page 5: AcknowledgementsThis evaluation of
Page 8 and 9: LHWP - Systems ReviewThe Management
Page 10 and 11: LHWP - Systems Review• Contributi
Page 12 and 13: LHWP - Systems Review• External c
Page 16 and 17: LHWP - Systems Review8 Performance
Page 18: LHWP - Systems ReviewTable C.2 Stra
Page 21: RPIURs.SCF-UKSCF-USSNIDsSoEsTAMATB-
Page 24 and 25: LHWP - Systems ReviewTo do this she
Page 26 and 27: LHWP - Systems Review• LHW appoin
Page 28 and 29: LHWP - Systems Review2.2 System per
Page 30 and 31: LHWP - Systems Review3.1 Systems an
Page 32 and 33: LHWP - Systems ReviewTable 4.1YearP
Page 34 and 35: LHWP - Systems Reviewto remain unch
Page 36 and 37: LHWP - Systems ReviewTable 4.7Numbe
Page 39 and 40: Training system5 Training system5.1
Page 41 and 42: Training systemTraining delivery is
Page 43 and 44: Training systemTrainer’s database
Page 45 and 46: Training systemTable 5.2Percentage
Page 47 and 48: Training systemTransfers of trainer
Page 49: Training system8. Quality of traini
Page 52 and 53: LHWP - Systems ReviewThe forecast f
Page 54 and 55: LHWP - Systems ReviewFigure 6.2Outl
Page 56 and 57: LHWP - Systems Review6.4 System per
Page 58 and 59: LHWP - Systems Reviewo The minutes
Page 60 and 61: LHWP - Systems ReviewTable 6.4Perce
Page 62 and 63: LHWP - Systems Review• Lack of lo
Page 65 and 66:
Salaries and payments system7 Salar
Page 67 and 68:
Salaries and payments systemThe POL
Page 69 and 70:
Salaries and payments system7.5.2 S
Page 71 and 72:
Performance monitoring of LHWs8 Per
Page 73 and 74:
Performance monitoring of LHWseduca
Page 75 and 76:
Performance monitoring of LHWsTable
Page 77 and 78:
Performance monitoring of LHWsNon-p
Page 79 and 80:
Transportation9 Transportation‘We
Page 81 and 82:
Transportationvehicle access from e
Page 83 and 84:
TransportationThe database shows th
Page 85:
Transportationdelays. These problem
Page 89 and 90:
Management information system• DP
Page 91 and 92:
Management information systemand th
Page 93 and 94:
Management information systemFigure
Page 95:
Conclusion11 ConclusionThe performa
Page 99:
Annexes77
Page 102 and 103:
LHWP - Systems ReviewChange/additio
Page 105 and 106:
AnnexesAnnex B Personnel positions
Page 107 and 108:
AnnexesAnnex C MIS and the measurem
Page 109 and 110:
AnnexesTable C.4Strategic Plan KPIs
Page 111:
AnnexesTable C.6Specific objectives
show all

LHW Systems Review - Oxford Policy Management

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?