How does community HMIS work? perception of lady health workers and supervisors about LHW-MIS in tehsil Mansehra, NWFP

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Introduction Information systems are important for measuring and improving the quality and coverage of health services. One of the determinants in health inequalities in developing countries is lack of reliable information. According, to a study Less than 90 countries contributed age and sex death statistics and cause specific death statistics to the WHO data bank. In 1994 the government of Pakistan launched a primary health care programme to deliver a range of services related to maternal and child health through Lady Health Workers (LHWs). LHWs also collect information regarding basic health indices and utilization of services (called LHW-MIS), which is aggregated at the national level and form an important part of national health statistics. It is generally assumed that being part of the communities they can easily visit and collect good quality health information. This study is a review of LHW-MIS in Tehsil Mansehra, NWFP Pakistan and explores the practices of MIS record keeping, reporting, support and supervision mechanisms and identifies areas of improvement which are essential to enhance performance, improve quality and better management. Methods The study was conducted in Tehsil Mansehra of District Mansehra, NWFP Pakistan. A mixed method study involving both qualitative and quantitative methods was use. The study design is Concurrent Triangulation Design. Using purposive and convenient sampling 25 semi-structured interviews were conducted with LHWs, Lady Health Supervisors (LHSs) and District Staff. Qualitative analysis was done manually. A checklist was used to review LHW-MIS tools. Descriptive analysis was carried out to validate information of MIS data in the tools and LHW registers from the community. Results LHWs work according to a monthly schedule. They are regular in transmission of MIS monthly reports. Most of LHSs consider 70-80 percent of LHW-MIS data of good quality. LHSs have difficulty in supervision due to too many workers. Some workers especially integrated from Population Welfare Department were reported weak in MIS. MIS refreshers are regularly conducted however; quality of trainings and trainers needs to be evaluated. MIS record review showed that out of 15 LHWs only 11(73.33%) had map of the catchment area. Community chart was updated by only 9 (60%) of the 15 LHWs. Only 2 of LHWs had number of referral feedback slips consistent with number of referrals. Health committee meeting was conducted by 11 (73.33%) out of 15 and women group meeting by 10 out of 15 LHWs. Consistency of information between monthly report and MIS registers was found for only 10 (66.67%) LHWs. Twelve LHWs had growth cards with them and only 3 (25%) had cards consistent with number of children. In the information validation results, out of 11 only 7 (63.64 %) health committees were confirmed as being held by the committee members. 11(78.57 %) out of 14 pregnant women confirmed the LHW visit.. 11 (73.33 %) out of 15 respondents confirmed LHW visit for child monitoring Conclusion LHW-MIS is a very useful and effective tool. LHWs are regular in transmission of monthly reports but the quality of information gathered and reported needs improvement. Incomplete and not up to date information was found in their registers. Community mobilization and involvement is required to support and monitor LHW in the field. Number of LHWs with each LHS needs to be decreased for better supervision. Effective and supportive management for smooth and proper coordination of activities is essential.

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