Abstract
BackgroundPakistan’s Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care.MethodsThis study is part of an implementation research project titled “Nigraan” (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding integrated community case management (iCCM) of diarrhoea and pneumonia were also assessed. Fourteen focus group discussions and 20 in-depth interviews were conducted as part of this qualitative inquiry. Analysis was done using QSR NVivo version 10.ResultsMost LHWs and LHSs identified pneumonia and diarrhoea as two major causes of death among children under-five. Poverty, illiteracy, poor hygiene and lack of clean drinking water were mentioned as underlying causes of high mortality due to diarrhoea and pneumonia. LHWs and LHSs gaps in knowledge included classification of dehydration, correctly preparing ORS and prescribing correct antibiotics in pneumonia. Lack of training, delayed salaries and insufficient medicines and other supplies were identified as major factors impeding appropriate knowledge and skill development for iCCM of childhood diarrhoea and pneumonia. LHWs considered adequate supervision and the presence of LHSs during household visits as a factor facilitating their performance. LHWs did not have a preference for written or verbal feedback, but LHSs considered written individual feedback to LHWs to be more useful than group and verbal feedback.ConclusionLHWs have knowledge and skill gaps that prevent them from providing effective care for diarrhoea and pneumonia. Enhanced supportive feedback from LHSs could improve LHWs skills and performance.
Highlights
Pakistan’s Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan
The purpose of this study is to explore Lady Health Workers (LHWs) and Lady Health Supervisors (LHSs) perspectives on the role of supervision in improving LHWs performance and motivation and their knowledge and skills for integrated community case management (iCCM) of diarrhoea and pneumonia
LHWs had worked with the Lady Health Workers Programme (LHW-P) between 5 and 10 years, and LHSs between 5 and 22 years
Summary
Pakistan’s Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. CHWs are geographically closer and more readily available than health facilities, and as residents of the local community they can provide care without cultural and linguistic barriers. Their knowledge and skills are vital in providing integrated community case management (iCCM) of pneumonia and diarrhoea. Incorrect diagnosis was a key problem which preceded two-thirds of all treatment errors In each of these studies, CHWs had deficiencies in clinical skills and faced several logistic obstacles in providing care to children with pneumonia and diarrhoea [8, 9]
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