Assessing the knowledge skills, ability and performance of paramedical staff in delivering primary health care sevices: a case of District Jamshoro Sindh Pakistan

Date of Award


Document Type


Degree Name

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


Community Health Sciences


Background A significant proportion of Pakistan's population depends upon PHC level health facility to meet their health care needs. Paramedics are considered to be the backbone for delivery of effective health services at PHC level. They have a far greater role when they act individually in the rural areas where doctors are not present due to a variety of reasons. However, even if sufficient numbers of health personnel are available they alone cannot lead to the desired change in health outcome. A Commensurate level of knowledge, skills and ability among the PHC paramedics is essential for proper health care delivery. In addition to good competency, their optimal performance is also influenced by a variety of others factors like motivation, chances of professional growth and clear job description etc. Measuring the competence level of PHC paramedics is therefore vital to determine their ability and readiness for service provision. It is also vital to determine factors influencing their competency/performance. Only through such assessment we would be in a position to provide evidence to policy makers for planning appropriate strategies in order to ensure a good health outcome. Methods The study was conducted in District Jamshoro Sindh, Pakistan. It was a mixed method approach based on sequential explanatory design; which is a strategy characterized by collection and analysis of quantitative data followed by collection and analysis of qualitative data. The quantitative data was collected using a modified self administrative, 360 degree evaluation tool where the individual was ranked by her/himself, peer and supervisor with regard to his/her knowledge, skills, ability and performance. Using convenient sampling, survey was conducted with 64 paramedics who include dispensers, medical technicians, LHVs/Midwives. Descriptive analysis was done and reliability between raters was confirmed by calculating Pearson correlation. Based on quantitative findings in-depth interview guidelines were developed. Using convenient and purposive sampling, nine interviews were conducted with paramedics and supervisors and analysis was done manually. Results In the quantitative survey, majority of the paramedics have reported good knowledge, skills and ability in collaborative relationship. In area of communication about 50% reported lack of appropriate good theoretical background in communication. In areas of health promotion approaches 23% to 34.6% of paramedics had good knowledge, 24% to 48% had good skills & ability only 22% to 26% reported good performance. Lack of awareness about health related laws and policy was reported by 95% of paramedics. In therapeutic relationship 67% to 94% reported good knowledge, skills and ability. Good competency in area of referral of patients was reported by 60% to 87% paramedics. A good knowledge in dispensing was reported by only 6% of dispensers. About 9% of health technicians had good knowledge about health assessment while 17% had good knowledge in provision of basic therapy. Good knowledge among LHVs and midwives in early detection of pregnancy related complications was reported by 41% respondents. In the area of task specific service provision, 39% reported good knowledge, 67% to 68% had good skills and ability. Similarly 24% had good knowledge about family planning approaches, but only 20% reported good performance in this area. The factors which lead to good competency development in certain areas were: good social interaction, proper training and routine practice of those tasks. On other hand weak competencies were linked with lack of: awareness/background knowledge, job description, practical utility, motivational factors, supervision/monitoring. Conclusion The above findings indicate that there is a critical need for capacity building among PHC paramedics. They were competent enough in certain areas and felt comfortable in performing tasks assigned to them. However deficiency has been reported visibly in theoretical background by most of them. The participants perceived themselves as more competent in more areas of core competency, whereas they felt themselves deficient in task specific areas. Variation in competency was linked with different factors including, social interaction, capacity building, lack of theoretical background, lack of resources, incentives, monitoring and supervision etc. It is felt that policy makers should formulate proper strategy to overcome such short-comings so as to ensure competent staff at PHC.

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