LHW Systems Review - Oxford Policy Management

LHWP – Systems ReviewLHS checklist The LHS checklist is used to inspect an LHW’s service delivery, check herknowledge and provide a Performance Score. Over 80 percent of LHSs reported using theirchecklist on their previous supervision visits; of these, almost 40 percent had informed eachLHW of her score, with almost two thirds of the LHSs writing the score in the LHWs’ diaries.The results vary between provinces, with LHSs in NWFP and AJK/FANA being more likely touse the checklist.Figure 8.2Percentage of LHSs that LHWs reported as using a checklist in theprevious supervision visitSource: OPM LHWP 4th Independent Evaluation, Quantitative Survey data, 2008Performance feedback by LHS to LHW As already stated, the LHS checklist provides atool with which the LHS can monitor the LHW and provide feedback. Almost one quarter ofLHSs reported having an LHW who had scored lower than 60 percent for three consecutivemonths in the previous year. The main actions they reported taking were to discuss theresult with the LHW, provide closer supervision, and discuss the problem with themanagement at the DPIU.Other factors supporting performance High-performing LHWs tend to have functioningWomen’s Health Committees. As this is a part of their job, again, it is not surprising.However, reinforcement might occur where, as the community becomes more engaged, itacts to increase the accountability of the LHW. LHWs who have been working for over 10years have a Performance Score that is, on average, 8.4 percent higher.Management and monitoring practices are shown to improve LHW performance:• consistent priorities for service delivery (adopted by the district, the LHS, and theLHW) result in higher performance;• district management support where the EDO-H fulfils a leadership role, and there ismanaging and monitoring by the DPIU;• provincial monitoring by the FPOs;• LHSs who provide monthly supervision (where they visit the LHWs and theirhouseholds (with and without the LHWs) and use their checklist) have higherperformingLHWs;• The LHS is expected to report on non-performing LHWs at the monthly meeting;• functioning health facilities where an individual person has responsibility for theProgramme and attends meetings at the DPIU; and• high-performing LHWs also have functioning Women’s Health Committees.54