LHW Systems Review - Oxford Policy Management

LHWP – Systems ReviewFigure 8.1Levels of service provision by high-performing LHWs and lowperformingLHWs, and a comparison with the second-to-lowestgroup of performers from 2000Note: The ten services, in the order presented in Box 2.Source: OPM LHWP 4th Independent Evaluation, Quantitative Survey data, 2008.Busy at workThe survey did find, unsurprisingly, that service delivery is higher when LHWs work morehours. The policy is for LHWs to visit all registered households regularly (visiting five toseven households each working day) and that an LHW must, in her normal routine, visit allhouseholds in her catchment areas at least once a month.In the week prior to the survey, 44 percent of the LHWs reported working seven days a week(Table 8.1). This is not in accordance with Programme policy. Field visits to LHWs by theevaluation team confirmed that this was a common practice, and that it was being reinforcedwith monitoring by the LHSs. The LHWs in Sindh and NWFP reported this practice as areason for their looking for an alternative job. Our analysis shows that LHWs who workseven days a week have significantly lower Performance Scores. In our judgement, backedup by discussion with LHWs in the field, we believe that LHWs should have one day off eachweek, except in the case of emergencies.The average number of hours worked by LHWs each week has increased from 20 hours in2000 to 30 hours in 2008, with almost 60 percent of LHWs working more than 25 hours. 68LHWs who are not involved in NIDs are still working, on average, around 20 hours. Also,there are still 20 percent of LHWs (70 percent in Balochistan) who worked fewer than 15hours in the week preceding the survey.68See Quantitative Survey Report, August 2009, for additional data.52