Supportive supervision of LHWs can make a difference: NIGRAAN implementation research


KARACHI: Strengthening supportive supervision by Lady Health Supervisors through household supervisory visits and written feedback could significantly improve Lady Health Workers’ skills for managing childhood diarrhoea and pneumonia in rural Sindh.

Communication between LHSs – usually one in each union council – and LHWs through simple mobile phones can also result in timely reporting by LHWs and prompt feedback provision for appropriate management of cases by LHSs.

This was revealed at a dissemination seminar about NIGRAAN, a two-year research project in district Badin by the Aga Khan University’s Department of Community Health Sciences in collaboration with the Health Department, Government of Sindh.

The project is funded by the Alliance for Health Policy and Systems Research, an international collaboration hosted by the World Health Organization. Started on September 1, 2013 it will be completed on October 31 this year.

“The project aims to identify ways for strengthening structured supportive supervision of LHWs in order to improve community case management of childhood diarrhoea and pneumonia in rural Sindh,” said Dr Fauzia Rabbani, Professor and Chair, Department of Community Health Sciences, AKU, and the principal investigator of the project.

On the occasion, Dr Khalid Shaikh, Department of Health, Government of Sindh, stressed the importance of evidence-based decision making for better child health outcomes.

Pakistan’s National Programme for Family Planning and Primary Health Care – launched in 1994 and commonly referred to as the Lady Health Workers’ programme – covers 60 per cent of the country’s rural population. It has a structured system of supervision where LHSs are responsible for on-going supervision and monitoring of the LHWs.

As first line community care givers, LHWs address major health problems of women and children, including pneumonia and diarrhoea that still contribute to 30 per cent of all deaths among children under five.

There are a total of 1,094 LHWs in district Badin, who are supervised by 36 LHSs.

The impact of household visit and written feedback by LHSs was evident with an improvement of 19 and 34 per cent in post NIGRAAN intervention LHWs’ knowledge and skills scores respectively.

Reporting also increased to 97 per cent due to the use of simple mobile phones, out of which 93 per cent cases were reported during the 24 hours of identification.

Based on the findings, researchers recommended a need for regular training and assessment, supportive supervision, timely and regular availability of operational funds, a SMS-based communication system between LHSs and LHWs, and further enhancing their role in the community.

Other key officials from the Department of Health who attended the meeting included Provincial Coordinator LHW Programme Dr Jai Ram Das and Assistant Provincial Coordinator Dr Pir Ghulam Hussain; district officials in Badin Dr Mehboob Khawaja, Dr Aijaz Ursani and Ms Taskeen Fatima; Deputy Director Development Dr Abdul Jabber Memon; and Deputy Provincial Coordinator Dr Ismail Memon. the seminar was also attended by Dr Farhat Abbas, Dean of Medical College, AKU and LHSs from the district Badin and the entire team of project NIGRAAN.