LAHORE/KARACHI/PESHAWAR:
For the average low-income girl who rushed into marriage with minimal knowledge of contraception, pregnancy and the complexities of childbirth, door-to-door visits from a female health worker (LHW) literally saved their lives. However, like all good things, social initiatives also come to an end quite quickly in Pakistan.
In 1994, the government launched the Lady Health Workers program, with the aim of improving maternal and child health outcomes. Each LHW was responsible for providing home consultations on family planning, antenatal care, childbirth and postnatal stages of the newborn to nearly 1,000 to 1,500 married women in their community.
However, after the Covid-19 outbreak, the government started using the services of LHWs for coronavirus, measles, typhoid, pneumonia and polio vaccination drives and dengue awareness activities, thereby depriving pregnant women and their unborn babies of dedicated healthcare and putting them at risk. to multiple health complications.
Sakina Bibi, a villager from the suburbs of Lahore, recounted the tragic loss of her grandchild due to childbirth complications. “As our village lacked medical facilities, the health worker was our savior. During the first days of my daughter’s pregnancy, she visited us regularly. However, over time, her visits became rare and “After seven months, my daughter suffered a premature stillbirth,” Sakina sadly shared.
A similar case was the case in southern Sindh, where low-income women of reproductive age faced gaps in healthcare delivery as 24,000 healthcare workers were distracted from their duties obstetrics and were responsible for vaccinating children for eight days a month. Currently, 3,000 LHWs and over 400 women health supervisors are deployed in Karachi.
In this regard, Halima Laghari Zulqarnain, central president of Sindh Health Workers and Employees Association and Community Health Workers Federation of Pakistan, told The Express Tribune that the provincial health department was giving mother-in-law treatment to health workers.
“It is not the job of health workers to vaccinate children. The main task of the LHW is to provide basic health facilities to newborns and pregnant women in rural areas. However, instead of to facilitate the accomplishment of the work of the agents, the government redirected them towards other campaigns”, regretted Zulqarnain.
The plight of LHWs was equally deplorable in Khyber-Pakhtunkhwa (KP), which continues to be one of the most unfortunate provinces of Pakistan, where maternal and child health remains alarmingly neglected. Despite government claims of improved healthcare, thousands of mothers continue to die in childbirth each year while more and more newborns bid farewell to the world long before they can even celebrate their first birthday.
Ayesha Khan, president of the Lady Health Workers Association, revealed that LHWs once played a central role in community healthcare as they knew every mother and child in their assigned areas, providing timely advice and providing prenatal care. “They were a key force in population control, but systematic neglect has undermined their effectiveness. In addition, many health worker positions remain vacant, which has exacerbated the crisis,” she said. , while adding that the focus on polio eradication had overshadowed broader health issues.
“Ignoring non-health workers could have long-term repercussions, as the province continues to face high rates of maternal and infant mortality,” she predicted.
According to the Pakistan Demographic and Health Survey, 1,900 mothers die every year in KP due to childbirth-related complications. However, proper use of contraceptives could save up to 800 lives each year. Similarly, the infant mortality rate stands at 53 deaths per 1,000 live births, but timely family planning could prevent 16,700 infant deaths per year.
Dr Sadia Usman, a gynecologist, was of the view that early marriages and lack of effective antenatal counseling were the major factors leading to infant and maternal mortality. “The majority of maternal and child deaths occur in rural areas where health workers bear all the responsibility. When you hire an ASB recruited for other tasks, they are distracted from their main task. Nearly 90 percent of all Maternal deaths among women aged 15 to 45 years occur due to preventable medical complications such as high blood pressure or postpartum hemorrhage,” Dr. Usman said.
According to information obtained by The Express Tribune, more than 250 women and 15,000 infants die out of 100,000 deliveries in Pakistan, with Punjab contributing 31 percent of deaths and Azad Kashmir and Gilgit-Baltistan reporting 69 percent of all deaths.
Dr Naveed Akbar Hotiana, a pediatrician at Ganga Ram Hospital and Fatima Jinnah Medical University, confirmed that remote areas lack ventilators, modern incubators and other necessary facilities for premature babies. “Before a newborn is brought to a tertiary health center, a lot of time has passed. For this reason, the mortality rate of newborns has increased. If health workers are made more active, the rate of maternal and child mortality can be significantly reduced,” said Dr Hotiana.
Sharing the LHW’s view, Rukhsana Bibi, a health worker, shared the difficulties she faced in her work after the government employed her for other services. “Sometimes we were assigned to campaigns to fight dengue and polio, while other times we were part of teams fighting pneumonia, measles and Covid-19. After all that, we We also have to visit women door-to-door and advise them on their reproductive problems,” lamented Rukhsana, who was protesting her meager salary and heavy workload.
“LHWs are overburdened with multiple responsibilities while their salaries are delayed by months. Moreover, the government has failed to implement a service structure and increase their salaries in the budget,” Khan confirmed.
On the other hand, Balochistan’s health workers occupy the lowest rung of the province’s overburdened health system. They are mostly underpaid, employed on precarious contracts and face hostility in many neighborhoods, where going door to door is often a risky ordeal due to the imminent threat of violence. In fact, several LHWs have been the target of attacks over the years, making their already difficult work even more perilous.
In 2014, four polio vaccinators were killed in a militant attack in Balochistan, three of whom were health workers. However, security concerns are not limited to the south-western province as domestic workers in Sindh face similar risks while carrying out their duties during campaigns against polio and other diseases.
“An LHW was raped during an anti-polio drive in Jacobabad two months ago, which our association also protested against,” revealed Zulqarnain.
Dr Khizar Hayat, provincial coordinator of the Maternal, Newborn and Child Health (MNCH) programme, acknowledged the program’s challenges but stressed the government’s commitment to reviving it. “New LHWs are being recruited in Kohat, and soon other districts will also see their numbers increase. Their tasks include tasks assigned by the government, be it polio or other campaigns. We have targets communities to achieve,” said Dr Hayat, speaking of the province which currently has 17,000 LHWs.
Responding to the grievances, a spokesperson for the Punjab Health Department confirmed that from 2019 to 2023, various additional duties had been given to female health workers. “Back then the staff was less, but today there are separate staff for each campaign and the burden on LHWs is less,” they replied. With an additional report from our correspondent in Quetta