PakAlumni Worldwide: The Global Social Network

The Global Social Network

Pakistan's Lady Health Workers "Best in the World"

“It’s one of the best community-based health systems in the world,” said Dr. Donald Thea, a Boston University researcher about Pakistan's Lady Health Workers Program. Thea is one of the authors of a recent Lancet study on child pneumonia treatment in Pakistan. He talked with the New York Times about the study.

Published in British medical journal "The Lancet" this month, the study followed 1,857 children who were treated at home with oral amoxicillin for five days and 1,354 children in a control group who were given standard care: one dose of oral cotrimoxazole and instructions to go to the nearest hospital or clinic. The home-treated group had only a 9 percent treatment-failure rate, while the control group children failed to improve 18 percent of the time.

Launched in 1994 by former Prime Minister Benazir Bhutto's government, Pakistan’s Lady Health Workers’ program has trained over 100,000 women to provide community health services in rural areas. The program website introduces it as follows: "This country wide initiative with community participation constitutes the main thrust of the extension of outreach health services to the rural population and urban slum communities through deployment of over 100,000 Lady Health Workers (LHWs) and covers more than 65% of the target population. The Programme contributes directly to MDG goals number 1, 4, 5 & 6 and indirectly to goal number 3 & 7. The National Programme for Family Planning and Primary Health Care is funded by the Government of Pakistan. International partners offer support in selected domains in the form of technical assistance, trainings or emergency relief."

A recent comprehensive review of the program found that as compared to communities not served by the LHWs, the served households were 11% more likely to use modern family planning methods, 13% were more likely to have had a tetanus toxoid vaccination, 15% more were likely to have received a medical check-up within 24 hours of a birth, and 15% more were likely to have immunized children below three years. The improvements in health indicators among the populations covered by the LHWs were not entirely attributable to the program alone; researchers noted that other positive changes such as economic growth, increased provision of health services and better education services helped to enhance the impact. While the program had managed to sustain its impact despite its large expansion, evaluators found that serious weaknesses in the provision of supplies, and equipment and referral services need to be urgently addressed.

The program is now a major employer of women in the non-agricultural formal sector in rural areas, and is being more than doubled in size if budget allocations can be sustained. If universal coverage is achieved, every community in the country will have at least one lady health worker, one working woman and potential leader, who could serve as a catalyst for positive change for women in her community. The health officials say that unlike the mid-1990s when it was difficult to recruit women because of the minimum 8th grade education requirement, now there are large numbers of women who meet the requirement lining up for interviews in spite of low stipend of just Rs. 7000 per month.

Private sector is also helping the LHW program. Mobile communications service provider Mobilink has recently partnered up with the United Nations Population Fund (UNFPA), Pakistan's Ministry of Health (MoH) and GSMA Development Fund in an innovative pilot project which offers low cost mobile handsets and shared access to voice (PCOs) to LHWs in remote parts of the country. Mobilink hopes to bridge the communication gap between the LHW and their ability to access emergency health care and to help the worker earn extra income through the Mobilink PCO (Public Call Office).

Due to economic downturn and security challenges in several conflict areas since 2008, Pakistan's chances of achieving its Millennium Development Goals (MDGs) by 2015 appear to be slim. However, significant timely expansion in the LHW program and making it more effective can still help Pakistan get close to its MDGs on important health indicators like the infant mortality rate (IMR) and the maternal mortality rate (MMR).

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Tags: Health, IMR, MDG, MMR, Pakistan, Workers

Comment by Riaz Haq on March 24, 2013 at 4:59pm

Here's Daily Times on more midwives for Pakistan:

Speakers at the second annual conference on Maternal and Newborn Health Programme have stressed the importance of research-based evidence to improve policies and practices related to maternal and newborn health in Pakistan.

The conference was held on Thursday, with the theme ‘Bridging the Gap – Evidence for Policy and Practice’. Findings and lessons from projects funded by Research & Advocacy Fund (RAF) were presented. Sessions focussed on the cost and financing of maternal and newborn health in Pakistan, socio-economic and cultural factors affecting maternal and newborn health and engaging with civil society to improve health outcomes.

Delegates from both the public and private sector, including provincial secretaries and director generals of health and heads of various national and international NGOs attended the event.

Planning Commission of Pakistan’s deputy chairperson, Dr. Nadeem ul Haq hoped the commission will learn from the research findings from RAF work.

Peter Upton, Director British Council, Desmond Whyms, Senior Health Advisor UKaid, Andrew Mackee, Acting Counsellor Development Cooperation AusAID and Sarah Hall, Programme Manager RAF also addressed the audience, stressing the respective commitments of their organisations to remain engaged in improving Pakistan’s health outcomes. The speakers highlighted the purpose of RAF, and stressed the need to share knowledge, information and strengthen collaboration between national, provincial and local public and private stakeholders to work together to improve maternal and newborn health in Pakistan.

“Women and children are the UK’s number one health priority in Pakistan” said Desmond Whyms. He claimed that by 2015, UK aid would have funded the training and deployment of 12,000 community based midwives, helped prevent the death of 3,600 mothers, delivered 350,000 more babies in hospitals and provided full immunisation for 280,000 children.\03\22\story_22-3-2013_pg11_3

Comment by Riaz Haq on August 9, 2013 at 4:16pm

Here's a story about a telehealth facility for women in Karachi:

Karachi: Pakistan’s largest city and commercial centre, Karachi, is a city of extremes where the richest live alongside the country’s poorest. Perfectly coiffed women with foreign degrees and fancy handbags tour around the city’s designer malls. At the other end of the spectrum, a range of hurdles leave women from the poorest sections of society struggling to access basic services, particularly healthcare.
But a recently launched telehealth service is hoping to change that by giving women in Karachi, Pakistan’s largest city with a population of around 18 million, access to basic health advice for free from a mobile phone.
“This is a big opportunity to improve access to woman in urban areas who have no access to basic healthcare and information, particularly during pregnancy,” says Zahid Ali Fahim, head of the telehealth service run by the Aman Foundation, a Pakistan-based non-governmental organisation. Dr Fahim oversees the 26-seat call centre that has been working around the clock for the past 18 months.
According to the World Health Organisation’s Global Health Observatory report, 40 per cent of premature deaths in adults in Pakistan would have been preventable through early intervention. Though there is no official WHO breakdown by gender, experts say a significant portion of those premature deaths are women. Distance to hospitals and clinics, the cost of transport, and low levels of trust in government-run services leaves men and women unable to seek the medical help they may need.
A strict social code for many women presents an additional obstacle. Low literacy rates — 57 per cent of women are illiterate in Pakistan compared with 26 per cent of men — and a lack of basic health knowledge compound the problem.
When women are able to travel to a clinic or hospital, they are usually accompanied by a male relative, leaving many unwilling — or unable — to explain their medical problem to the doctor.
“Women don’t want to get healthcare services without their [male relative] presence,” explains Dr Fahim, “But she cannot say anything when she goes to the facilities. The head of the family does all the talking.”...

Comment by Riaz Haq on August 31, 2013 at 7:38am

Here's an excerpt of a Dawn Op Ed on declining fertility rates in Pakistan:

Getting down to two children per family may seem an elusive target, however, Pakistanis have made huge dents in the alarmingly high fertility rates, despite the widespread opposition to family planning. Since 1988, the fertility rate in Pakistan has declined from 6.2 births per woman to 3.5 in 2009. In a country where the religious and other conservatives oppose all forms of family planning, a decline of 44 per cent in fertility rate is nothing short of a miracle.

A recent paper explores the impact of family planning programs in Pakistan. The paper uses data from the 2006-07 Pakistan Demographic and Health Survey, which interviewed 10, 023 ever-married women between the ages of 15 and 49 years. The survey revealed that only 30 per cent women used contraceptives in Pakistan. Though the paper in its current draft has several shortcomings, yet it still offers several insights into what contributes to high fertility and what the effective strategies are to check high fertility rates in Pakistan.

The survey revealed that the use of contraceptives did not have any significant impact for women who had given birth to six or more children. While 24 per cent women who were not using any contraceptives reported six or more births, 37 per cent of those who used contraceptives reported six or more births. At the same time, 27 per cent of women who were not visited by the family planning staff reported six or more births compared with 22 per cent of women who had a visit with the family planning staff.

Meanwhile, demographic and socio-economic factors reported strong correlation with the fertility outcomes. Women who were at least 19 years old at marriage were much less likely to have four or more births than those who were younger at the time of marriage. Similarly, those who gave birth before they turned 19 were much more likely to have four or more births.

Education also reported strong correlation with fertility outcomes. Consider that 58 per cent of illiterate women reported four or more births compared to 21 per cent of those who were highly educated. Similarly, 60 per cent of the women married to illiterate men reported four or more births compared to 39 per cent of the women married to highly educated men. The survey revealed that literacy among women mattered more for reducing fertility rates than literacy among their husbands.

The underlying variable that defines literacy and the prevalence of contraceptives in Pakistan is the economic status of the households. The survey revealed that 32 per cent of women from poor households reported six or more births compared to 21 per cent of those who were from affluent households.

The above results suggest that family planning efforts in Pakistan are likely to succeed if the focus is on educating young women. Educated young women are likely to get married later and will have fewer children. This is also supported by a comprehensive study by the World Bank in which Andaleeb Alam and others observed that cash transfer programs in Punjab to support female education resulted in a nine percentage point increase in female enrollment. At the same time, the authors found that those girls who participated in the program delayed their marriage and had fewer births by the time they turned 19.

Comment by Riaz Haq on September 14, 2013 at 10:04pm

Here are some findings of UNICEF's Child Survival Report 2013:

1. Pakistan's infant mortality rate is ranked 26th worst in the world.

2. Pakistan remains high though it has been coming down from 138 per 100,000 in 1990 to 112 in 2000 to 86 in 2012.

3. Pakistan is among the five countries (India 22%, Nigeria 13%, Democratic Republic of Congo 6%, Pakistan 6% and China 4% in that order) across the world where half of all under-five deaths occur.

4. The report recommends exclusively breastfeeding all newborns till six months of age, immunizing children and newborns with all recommended vaccines, and eliminating all harmful traditions and violence against children. To ensure children grow up in a safe and protective environment. Besides this feed children with proper nutritional foods and micronutrient supplements, where available, and de-worm children; give oral rehydration salts (ORS) and daily zinc supplements for 10-14 days to all children suffering from diarrhea.


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