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Learning and Performance Management (LPM)
Improving health worker performance and health outcomes
Improving health worker performance and health outcomes
What is LPM?
Learning and Performance Management (LPM) is a term that includes any strategy to help health workers (HW) improve and maintain their performance. Gavi, the Vaccine Alliance aims to support countries in implementing evidence-based LPM approaches that are tailored to their unique needs and context. More strategic LPM will improve the quality of services and lead to better health outcomes.
Why is strengthening LPM important?
Improved health outcomes: Globally, 1.5 million people lose their lives to vaccine-preventable diseases every year, and 25 million children are under-immunised. In Gavi-supported countries in 2021, there were 12.5 million "zero-dose" children who have not received even a single vaccine shot. Reaching these missed children and their communities is only possible if HW are skilled and well supported.
Motivated health workers: The goal of putting HW needs at the centre of LPM is to reinforce their competence, and to improve their motivation and performance.
Better value for money: Global health organisations’ current large investments in traditional lecture-style classroom training and supervision have not had the expected impact on HW performance. Better value for money is achieved through a combination of the more effective LPM approaches described below.
Simplification of digital landscape: During the COVID-19 pandemic, the use of digital technology for LPM increased exponentially. The effects of this increase on HW performance have been mixed, often being small to modest. The decision on whether and how to use digital interventions should be based on evidence of effectiveness, suitability for the context and cost; and all interventions should be monitored.
How to transition towards strategic LPM?
Understand the context: Conduct a needs assessment to identify areas of improvement regarding HW performance; identify existing data; and determine the root causes. Additionally, mobilise existing resources and partners that can support these areas. Based on this analysis, develop an LPM strategy, and select the most suitable approaches and solutions for the context to address the identified areas of improvement.
Combine approaches: Multifaceted strategies that combine training with other interventions, such as supervision or group problem-solving, have greater effects on HW performance than these interventions in isolation. Providing the basics (e.g. equipment and supplies) is essential, but this should be complemented by interventions shown to improve HW performance. Training is best done at the workplace, but there are other effective delivery methods (e.g. self-paced, digitally supported and peer-to-peer learning). Supervisors themselves should receive supervision; be trained in mentoring and root-cause analysis; and participate in problem-solving with HW.
Monitor for impact: For any LPM strategy, it is important to monitor HW performance and use the results to determine if the intervention needs further adaptation for greater impact. Choose simple indicators that can be measured during routine supervision visits.
Available resources
For identifying opportunities to improve HW performance:
For evidence:
- Transforming Learning and Performance Management for Immunization Health Workers
- The Health Care Provider Performance Review, evidence on the effectiveness of different interventions
For evaluating solutions:
Guiding principles
These five guiding principles serve as the foundation for impactful programmes to strengthen LPM and improve HW performance:
1. Impactful
Use evidence-based approaches that are monitored and evaluated for impact on HW performance and evolve based on results.
2. Country-driven
Implement context-appropriate approaches that align with national priorities and are driven by national stakeholders.
3. Sustainable
Implement maintainable and adaptable LPM approaches; encourage country ownership and buy-in for better sustainability.
4. Learner-centric
Put HW at the centre; select and adapt approaches that reinforce learners’ motivation, confidence and competence.
5. Digitally supported
When indicated based on needs and landscape, support LPM approaches with evidence-based digital solutions that do not burden HW.
FAQ
What is Learning and Performance Management (LPM)?
LPM is a term that includes any strategy to help health workers (HW) improve and maintain their performance. Gavi, the Vaccine Alliance aims to support countries in implementing evidence-based LPM approaches that are tailored to their unique needs and context. More strategic LPM will improve the quality of services and lead to better health outcomes.
What do we mean by health worker performance?
HW performance means how well vaccinators and other Expanded Programme on Immunization (EPI) staff – and more broadly, the staff of other health programmes – adhere to national guidelines or otherwise work in ways that help achieve programmatic objectives. EPI examples include: how HW interact with patients (e.g. proper counseling; safely administering vaccines) and broader programmatic actions (e.g. using data to identify zero-dose children; effective microplanning of vaccination outreach). More generally, when HW perform well, they are providing high-quality services. Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. High-quality care should be effective, safe, people-centred, timely, equitable, integrated and efficient.
Who is the target group for LPM?
LPM can be designed for any health workers (HW). The focus of LPM efforts to date has been on the professional and legally recognised frontline health workers (FHW) such as nurses, midwives, medical doctors and health workers responsible for the delivery of vaccines. There are differences when considering LPM strategies for this group compared to community health workers (CHW) or in-office personnel.
Why should we rethink LPM approaches?
To reach national goals, keep health systems functioning efficiently and improve quality of care, it is critical that health workers receive continuous learning and enhance their skills amid ever-changing health challenges. With more effective LPM, it is possible to use money and time more effectively, keep health workers more motivated and reach better health outcomes.
What is the difference between an LPM approach and an LPM solution?
Different approaches (such as blended learning, group-based problem solving, supportive supervision, mentorship) are used to improve health worker learning and performance management.
Chosen approaches are then supported with sustainable and scalable LPM solutions. Solutions are services, products or technology platforms that support learning and performance efforts; and are maintained by a specific solution provider (e.g. standalone technology platform; software platform with associated delivery model).
Who has been working on LPM?
A working group comprising experts from Gavi, the Vaccine Alliance; its founding partners (WHO, UNICEF, Bill & Melinda Gates Foundation, World Bank); the US Centers for Disease Control and Prevention; and the Global Fund to Fight AIDS, Tuberculosis and Malaria provided inputs and contributions to the resulting vision, strategy and recommendations to improve HW performance.
Where to look for more information?
For more information, see “Available resources”, and Gavi Programme Funding Guidelines.
Last updated: 1 May 2023