Fauziah Rabbani, Agha Xaher Gul, Shagufta Perveen.
Overcoming the MDG 4 implementation challenges: redefining the role of LHS in structured supportive supervision of lhws.
Pak J Public Health Jan ;2(4):52-4.

Millennium Development Goal (MDG) 4 calls for a two-thirds reduction in under-five mortality from 1990 levels by 2015. Of the 68 countries with the highest burden of child mortality, 52 will not achieve MDG 4. Pakistan is among the 52 countries that are not on track to achieve MDG 4. Despite the deployment of some 120,000 Lady Health Workers (LHWs), under-five mortality in Pakistan has remained stagnant over the last decade. With 2015 around the corner, it is time to reassess current implementation challenges and generate new evidence on how to strengthen the National Program for Family Planning and Primary Health Care to accelerate the pace towards achieving MDG 4. The Fourth Evaluation of the LHW program (FENP) identifies deficient knowledge and skills of LHWs in community case management of pneumonia and diarrhea and weak supervision by Lady Health Supervisors (LHSs) as significant shortcomings of the Program. The evaluation also notes persistent issues with key health behaviors of primary caregivers (mothers) related to these childhood illnesses and suggests that an association exists between LHS supervisory competencies, LHW knowledge and skills and key health practices of primary caregivers related to pneumonia and diarrhea in children under five. In the context of Pakistan’s weak health system, structured supportive supervision of LHWs by LHSs through LHS trainings and augmentation of existing LHS monitoring tools might be a key step in reducing Pakistan’s target gap for MDG 4.

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