LHW Systems Review - Oxford Policy Management

Performance monitoring of LHWs8 Performance monitoring of LHWs“We visited an LHW who had not had an LHS for a year and asked her what impact this had.She said that the LHS was useful to reinforce messages in the households. As she was welleducated and came to visit in a vehicle, people found her credible and listened to her. TheLHS had also helped the LHW review her training materials. The LHS had the experience ofvisiting many villages and could provide advice on how to deal with situations.” (EvaluationTeam)8.1 PurposeTo provide performance information on the LHWs that can be used to trigger action aimed atimproving performance or resulting in termination. 598.2 Performance measures• All LHWs have a supervisor; 60• 75 percent of LHWs receive a supervisory visit once a month; 61• All registered households are regularly visited by their LHW. 62 LHWs work six days aweek, visiting between five to seven households every working day, and ensure a revisitevery two months; 63• The LHS gives comprehensive feedback to the LHWs on issues noticed during thevisit; 64 and• Non-performing LHWs are, after due process, terminated.8.2.1 DescriptionDistricts have hundreds, and sometimes thousands of LHWs. The DC and the ADC (typicallya female) are the managers of the LHS, who is the direct supervisor of the LHWs andresponsible for management of their performance.Lady Health Supervisor (LHS) The LHS has two roles: one as a supportive coach; theother as an inspector, to ensure that LHWs are providing the required services. The LHSshould supervise, on average, 25 LHWs in their communities. She should visit each LHW atleast once a month, preferably twice, and attend the LHW monthly meeting at the healthfacility.The LHS has a checklist to use for inspection that covers: the testing of an LHW’sknowledge and verification of her record-keeping, which includes visits to households theLHW serves in the community. In the LHS manual, the LHS is instructed to provide feedbackto the LHW at the time of monitoring: If the LHW has scored:59The Strategic Plan refers to the cost of low-performing LHWs. They ‘are a significant drain on Programme resources and whoare unlikely to be delivering services that change health and poverty outcomes’ (Strategic Plan, LHWP: 13). The 3rd Evaluationfound that low-performing LHWs provided only 17 percent of their eligible clients with services.60Strategic Plan, LHWP: 21.61Strategic Plan, LHWP: 21.62Strategic Plan, LHWP: 19.63Working days are six days a week, but on the understanding that, if there is an emergency requiring referral, the LHW willrespond.64District Supervision and Monitoring manual: 47.49