LHW Systems Review - Oxford Policy Management

LHWP – Systems Reviewpay for printing results in training having to be scheduled for the second half of theyear;• Inefficiencies in other systems can lead to delays For example, selection ofLHWs, printing supplies, and training allowances;• Insufficient incentives for high quality training There are few sanctions that canbe applied to health facility personnel if training is not up to standard;• Unapproved training programmes LHWs have attended unapproved trainingprogrammes, causing a risk to quality control and to the perception of the role of theLHW, both by the community and herself; and• Contracting out the management of the Basic Health Units This has leading tocases of trainers not being made available by the contractor for the trainer training offacility staff. There have also been examples where facility staff members were nolonger permitted to train LHWs. Some of these issues have been resolved in somedistricts, but the experience does show up the risks of detaching the LHWP from thecore health service provision.5.7 Findings1. Professional knowledge and skills The LHWP has continued to invest in theprofessional knowledge and skills of the LHW. The knowledge score of the LHW andher supervisor has increased since 2000. The average score in the Knowledge Testfor LHWs was 74 percent and, for LHSs, 78 percent. Knowledge scores were higherin NWFP and AJK/FANA for both LHWs and LHSs;2. Programme target The Programme target was for 90 percent of LHWs to score over80 percent in the Knowledge Test. There are now 31 percent of LHWs who scoredover 80 percent in the Knowledge Test, compared with 16 percent in 2000. AnotherProgramme target was that all LHWs have a knowledge score of over 71 percent.Two thirds of LHWs achieved this target;3. Low levels of knowledge However, 11 percent of LHWs scored less than 60 in theKnowledge Test and LHWs in Balochistan had considerably less knowledge with anaverage score of only 64 percent. The Programme needs to address this issue aslack of knowledge is a risk for the LHWs clients. The fault cannot be with the trainingsystem per se. It is important that the Balochistan PPIU take responsibility forimproving the level of LHW knowledge in their Province;4. Contributing factors Duration of service and level of education contribute to thelevel of LHW knowledge. Knowledge is also higher amongst those LHWs whoreceived training at their last monthly meeting at the health facility, and for those whoattended the Food and Nutrition training course in the previous year. However, asignificant improvement is gained through attending Counselling Card refreshertraining. LHWs that have the Counselling Card manuals have considerably higherknowledge scores;5. Refresher training can make a significant difference to knowledge and performance,depending on the topics and the training materials. Counselling Card refreshertraining is improving the level of knowledge, and Revised MIS tools refresher trainingsignificantly improves performance;6. Trainer training Essentially, the system has remained unchanged during this PC-1.It continued to deliver core training of LHWs and LHSs, using the trainer trainingmodel;7. Training system The training provided for the expansion of the Programme between2003 and 2008 was managed in a similar manner to previous expansions. Thesystem increased its throughput with a substantial programme of refresher training;26