LHW Systems Review - Oxford Policy Management

Executive summaryIntroductionThe review of management and systems is one of the areas covered by the 4th Evaluationof the National Programme for Family Planning and Primary Health Care (Lady HealthWorker Programme). 1 This fourth external evaluation of the LHWP, by Oxford PolicyManagement (OPM), began in December 2007 with the objective of evaluating the periodcovered by the PC-1, 2 from July 2003 to June 2008. 3The terms of reference for the evaluation were as follows:• to provide the Ministry of Health and other stakeholders with accurate, credible andusable information on the LHWP performance;• to examine changes in the Programme’s performance since the 3rd Evaluation;• to explore the determinants of performance;• to identify socio-economic benefits to stakeholders and communities; and• to provide findings and policy options enabling the Programme to further strengthenits performance.To fulfil these objectives the key outputs of the evaluation are:• Final Summary Report;• Quantitative Survey Report;• Provincial Survey Reports for Punjab, Sindh, NWFP, Balochistan and AJK/FANA;• Management Review and Systems Review (this report);• Finance and Economic Analysis; and• Lady Health Worker Study of Socio-Economic Benefits and Experience.The evaluation tools included: a nationwide sample quantitative survey (based on thequestionnaires of the 3rd Evaluation to ensure comparability of results); a qualitative study tosupplement the quantitative survey; financial analysis; stakeholder interviews and meetings,and document reviews.The Systems Review and the Management Review are presented here as two companionvolumes. This report, Volume 1, covers the Systems Review and Volume 2 is theManagement Review.The Management and Systems ReviewsThe Management and Systems Review is presented as two reports.The system review report provides findings on the performance of selected core systemsusing the targets in the Strategic Plan and the PC-1. These systems include: selection ofLHWs, training, logistics, salaries and payments, performance management, transportation,and MIS; and1The Programme is officially called the National Programme for Family Planning and Primary Health Care (NP FP&PHC). It iscommonly referred to as the ‘Lady Health Worker Programme’, and is hereafter referred to as the ‘LHWP’ or the ‘Programme’ inthis report.2This is the core planning document of the Programme.3The most recent independent evaluation of the LHW P was commissioned by the Ministry of Health in 1999 and wasimplemented by Oxford Policy Management. This was the third independent LHW Programme evaluation. The key conclusionof this evaluation was that the LHWP had managed to buck the international and national trend of low-performing CommunityHealth Worker Programmes and was, in fact, providing a service that had an impact on key health indicators.iii