Preventive Health: “The role of lady health workers in creating awareness in Pakistan!”
Lady health workers (LHWs) provide primary health services to underprivileged communities and hence bridge the large gap in the rural and urban healthcare services and health workforce. They provide essential care by health promotion, disease prevention, curative and rehabilitative services and family planning in the community. Pakistan has a population of 180 million people and even though the doctor to population ratio has improved in recent years there is still a lack of sufficient nurses, paramedics and skilled birth attendants. There are just 1.4 nurses, midwives and doctors per 1000 as compared to the 2.28 required for the mean population. This concentration of doctors in the major cities and this has led to unmet health needs of the rural community and urban slum population. Pakistan lacks behind the international health targets and the lady health workers program (LHWP) helps establish primary care provision at the grass roots level.
The LHWP is special being one of the largest community health workers program in the entire world and a model for global communities. It brings Pakistan one step closer to achieving the millennium developmental goals set out by WHO. In 2010 Pakistan had the third highest newborn mortality rate. Nearly half the mother and children are malnourished with 1.5 million children acutely malnourished. LHWs increase awareness on reproductive health and nutrition which has helped bring down these rates significantly. They also encourage women to seek antenatal care during their pregnancy and direct them towards affordable government clinics. Most of the rural population has strong misconceptions about family planning hence family planning education and offering contraceptives is part of the LHWP. Over all this has led to improved maternal and child health with 20.9% lower neonatal mortality rate as compared to women using traditional services provided by dhais. Even though the prevalence of HIV/AIDs is low there is limited access to antiretroviral therapy. Hence there is a focus by LHWs on susceptible groups in the population such as mothers and children under five as well as those with HIV/AIDs. LHWs are also involved in strengthening the EPI to improve the vaccination status of women and children in low socioeconomic communities.
The effectiveness of LHWs can be seen concretely as women served by them are 11% more likely to use contraception, 13% more likely to get a tetanus toxoid and 15% more likely to attend a medical facility within 24 hrs. of birth and immunize children under three. The program has provided healthcare to 60-70% of the rural population. A 2006 study in Punjab province showed Lady Health Workers contributed to a reduction in the maternal mortality rate from 350 to 250 per 100,000 live births and in the infant mortality rate from 250 to 79 per 100,000 live births. LHWs have established themselves as important liaisons within the primary health care system. The program has successfully accelerated Pakistan’s progress towards universal healthcare.
Even though the LHWs have made a significant impact on many lives the program faces many hurdles such as lack of adequate funding and poor management. There is a short fall in maintaining expenditure on key inputs such as contraceptives, vehicle maintenance, salaries and allowances. This has resulted in poor provision of care to the people by public health services. Overcoming these issues by increased funding, higher GDP allocation to healthcare and proper management of resources and supervision will allow LHWP to serve the target population efficiently and effectively in the future.
Syeda Asfia Hussain
Dow Medical College ‘19