By: Zohra S. Lassi, Zulfi Kahn, and Rose Zulliger
Pakistani Lady Health Workers each provide roughly 1,000 community members a range of health information services, including techniques for community management of and health education about common diseases. Each worker receives supervision on a monthly basis to assess adherence to care protocols. Pakistan continues to demonstrate a need to strengthen and expand their Lady Health Worker workforce to achieve Millennium Development Goals.
Background
The Lady Health Worker Program (LHW-P) was launched in 1994 as part of national strategy to promote health and reduce poverty by bridging the gap between health services and communities. The LHW-P seeks to provide high-quality integrated health services at the doorsteps of communities.
Implementation
Approximately 100,000 LHWs are deployed throughout all five provinces of Pakistan. These workers are attached to a local health facility, but they are primarily community based, working from their homes.
Roles/responsibilities
The scope of services provided by LHWs has grown from an initial focus on maternal and child health to include participation in health campaigns of all types, community management of tuberculosis, and health education about HIV/AIDS. Each LHW has, on average, a catchment area of 1,000 individuals. LHWs visit an average of 27 households a week, providing advice and conducting consultations with an average of 22 individuals each week. LHWs also act as a link between the formal health system and the community.
Training
LHWs are initially trained in two phases for a total of 15 months. The first phase consists of 3 months of classroom training and the second phase is on-the-job training for 12 months. This should include 3 weeks of field work followed by 1 week of training per month for a period of 12 months as well as 15 days of refresher training each year, although there is substantial variation in training patterns across provinces. After finishing their formal training for 15 months, each LHW receives ongoing training during her tenure. This consists of attending the PHC Center one day a month for a refresher course.
Supervision
Supervision is highly organized and multi-tiered. LHWs are each attached to a public health clinic and are supervised by an LHW Supervisor. One LHW Supervisor is responsible for supervising 25 LHWs. LHWs should have community-based supervision at least once a month, at which time the LHW Supervisor meets with clients and with the LHW, reviews the LHW’s work using a structured monitoring checklist, and makes a work plan for the next month.
Incentives and remuneration
LHWs receive a salary of about US$ 180 per month. They are not supposed to engage in any other paid activity, although some do. The LHW stipend is a critical source of family support.
Impact
Pakistan has lagged behind in its achievement of the Millennium Development Goals. Although the LHW Program has many positive aspects, the number of LHWs is still not sufficient to provide adequate coverage of services nationally. Thus, expansion of the program and continued efforts at program strengthening are required to achieve a stronger impact.
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