Background: Little data is available about LHW-P managers and policy makers' understanding and perceptions to resolve the issue of stagnant under-5 mortality attributable to diarrhea and pneumonia. An exploratory qualitative study was done through Project NIGRAAN to assess provincial policy makers' views about the challenges encountered by LHW-P for improving the quality of services provided.
Methods: Seven face to face in-depth interviews were held complemented with semi structured questionnaire administered to nine senior and mid-level district and provincial level policy makers. Responses from both methods were grouped, compared and then merged to arrive at five themes; suboptimal skills and technical competence, motivation, governance and accountability, negligible supervision and weak management information system.
Results: Policy makers were aware that LHWs and LHSs' community case management (CCM) skills are suboptimal. Weak supervision, lack of training, irregular provision of salary and transportation were cited as major factors contributing towards this poor performance. A number of respondents considered LHWs to be overburdened but few suggested any solutions to reduce this work load. Health workers' motivation was considered to be affected by lack of supplies and dearth of recognition for their services. Although mindful of the important uses of data collected by LHW-P, policy makers did not comment on its utility for evidence-based decision making.
Conclusion: Policy makers are aware of the LHW-P challenges that lead to suboptimal CCM for childhood diarrhea and pneumonia. In the absence of political commitment and ownership, improvements in quality and performance will remain a dream