Pakistan faces several prominent healthcare challenges. These include: lack of basic healthcare services, a shortage of healthcare professionals, and insufficient infrastructure (Meghani, Sehar & Punjani, 2014; Abdullah, Mukhtar, Wazir et al., 2014). Many individuals in impoverished neighbourhoods in Pakistan endure high risks of infectious diseases, low immunisation rates, lack of medication, and limited nutrition (Shela, 2012; Asim & Nawaz, 2018; Zaidi, Murtaza, Mustafa & Awan, 2015).

Considering the high level of female unemployment in the country, female healthcare workers can mitigate these problems by improving access to healthcare services for poor communities while empowering women. This is especially relevant to low-caste women who face the greatest vulnerability to poverty. This can be achieved by creating a linkage between healthcare systems and the community. The Lady Health Worker Programme (LHWP) of Pakistan provides a leading example of how this can be achieved. 

 

The Lady Health Worker Programme 

Pakistan’s Ministry of Health (MOH) has implemented one of the largest community health worker programme’s in the world. The LHWP was initiated by former Prime Minister Benezir Bhutto in 1994 (Rabbani, Perveen, Aftab, et al., 2016). The programme is known to provide primary healthcare services to impoverished populations in both rural and urban areas. 

The programme’s services include:

  • Family planning
  • Providing health promotion and education activities
  • Immunisation
  • Case management of acute respiratory infection
  • Growth monitoring
  • Mental health screening
  • Referral to local healthcare facilities

(Fisher, 2017; Farooq, E- Nayab, & Arif, 2014). 

 

Training and employment

Unemployment is high among women in Pakistan (Zhu, Allen, Kearns, et al., 2014). The LHWP not only provides health services but also training and employment to many low-caste women in the country. There are currently 125,000 women employed as part of the programme (Adil, 2018). Each worker is assigned to a training programme in a specific government facility, a small subsistence allowance, as well as medical supplies. 

 

Programme impact

The LHWP has been successful in making progress towards achieving universal healthcare services accessible among the vulnerable, as well as contributing to narrowing the country’s gender equity gap (Zhu, Allen, Kearns, et al., 2014). Oxford Policy Management (OPM) performed a comprehensive review of the programme(Rawle, Cheema, &, Carraro, et al.,  2009). It has since been confirmed to have achieved the following impacts:

  • Increasing the childhood vaccination rate
  • Enhancing the uptake of antenatal services
  • Treating childhood diseases
  • Child growth monitoring
  • Breastfeeding advice
  • Preventative childhood health services
  • Increasing the use of contraception and tetanus vaccinations among women

(Zhu, Allen, Kearns, et al., 2014, 2014; Farooq, E- Nayab & Arif, 2014). 

 

Challenges

Pakistan continues to lag in key developmental indicators (Zulliger, 2018). Although the LHWP has been effective in strengthening the healthcare system, the number of health workers is still not sufficient to ensure adequate healthcare services in the country (Zulliger, 2018). 

Several weaknesses of the programme include: 

  • Irregular supply of medicines,
  • lack of training, and 
  • limited knowledge and skill development on certain diseases 

(Rabbani, Perveen, Aftab, et al., 2016; Hafeez, Mohamud, Shiekh, et al., 2011). 

 

Recommendations

The following recommendations are advised for the LHWP to achieve universal healthcare services for Pakistan’s marginalised population:

  • Workshops and courses for lady healthcare workers on a frequent basis to regain their knowledge.
  • Proper supervision by female healthcare professionals to improve the performance level of these workers, including successful vaccinations. 
  • Distributing a monthly package of medicines and other essential supplies. 

(Rabbani, Perveen, Aftab, et al., 2016; Hafeez, Mohamud, Shiekh, et al., 2011). 

 

Conclusion

As mentioned above, the LHWP is one of the largest in the world of its kind. It has improved healthcare services in the country and employed many marginalised women. The success of the programme serves an example for the global community aiming to empower women in developing countries. Owing to this success, the Pakistan Government should continue to invest its expansion and benefits to maximise impact. 

 

References

Abdullah, M.A., Mukhtar, F., Wariz, S., et al. (2014). The health workforce crisis in Pakistan: a critical review and the way forward,World Health & Population, 15(3), 4-12. 

Adil, H. (2018). The plight of Pakistan’s Lady Health Worker,Al Jazeera. Accessible: https://www.aljazeera.com/indepth/features/plight-pakistan-lady-health-workers-180410085710330.html

Asim, M. & Nawaz, Y. (2014). “Child malnutrition in Pakistan: Evidence from literature”, Children, 5(60), 1-15. 

Farooq, S., e-Nayab, D. & Arif, G. M. (2014). “Welfare impact of the lady health programme in Pakistan”, The Pakistan Development Review, 53(2), 119-143. 

Fisher, J. (2017). Pakistan lady health worker program, World Health Organization. Accessible: https://whoeducationguidelines.org/content/pakistan-lady-health-worker-program

Hafeez, A., Mohamud, B.K., Sheikh, M.R., et al. (2011). “Lady health workers programme in Pakistan: challenges, achievements and the way forward”,Journal of Medical Association of Pakistan

Meghani, S.T., Sehar, S. & Punjani, N.S. (2014). “Comparison and analysis of health care delivery system: Pakistan versus China”, International Journal of Endorsing Health Science Research, 2(1), 46-50. 

Murtaza, F., Mustafa, T., & Awan, R. (2015). “Child health inequalities and its dimensions in Pakistan”, Journal of Family & Community Medicine, 22(3), 169-174. 

Rabbani, F., Perveen, S. Aftab, W. et al. (2016). “Health workers’ perspectives, knowledge and skills regarding community case management of childhood diarrhoea and pneumonia: a qualitative inquiry for an implementation research project “Nigraan” in district Badin, Sindh, Pakistan”, BMC Health Services Research, 16(1), 462. 

Rawle, G, Cheema, I, Carraro, L, Javeed, S, Arif, S and Brook, S (2009). Evaluating the Lady Health Worker Programme, Oxford Policy Management: Accessible: https://www.opml.co.uk/projects/evaluating-lady-health-worker-programme

Shela, A. (2012). “Malnutrition in young Pakistani children”, Journal of Ayub Medical College Abbottabad, 24(2). 150-153. 

Tulenko, K. M. (2013). Community health workers for universal health- care coverage: from fragmentation to synergy. Retrieved September 6, 2018 from the World Wide Web: http://www.who.int/bulletin/ volumes/91/11/13-118745/en/. 

Zhu, N., Allen, E., Kearns, A., et al. (2014). Lady health workers in Pakistan. Maternal Health Task Force. Retrieved September 2, 2018 from the World Wide Web: https://cdn2.sph.harvard.edu/wp-content/uploads/sites/32/2014/09/HSPH-Pakistan5.pdf

Zulliger, R. (2018). Pakistan’s lady health worker program. CHW Central. Retrieved August 27, 2018 from the World Wide Web: https://www.chwcentral.org/blog/pakistan’s-lady-health-worker-program

Social Protection Programmes: 
  • Labour market programs/Public work/Productive inclusion
    • Labour market programs/Public work/Productive inclusion - General
    • Cash for work
    • Sustainable livelihood programmes
    • Training
Social Protection Topics: 
  • Coverage
Cross-Cutting Areas: 
  • Education
  • Gender
  • Health
    • Health - General
    • Child health
    • Maternal health
  • Inequality
  • Labour market
Countries: 
  • Pakistan
Regions: 
  • South Asia
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