WUNRN
Pakistan - Unsung Heroines for Village Health Care
By Zofeen Ebrahim
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KARACHI, Mar
16, 2011 (IPS) - At eight in the morning 30-year-old Sultana Solangi steps out
of her house ready for her day’s work. Wearing a black gown that shows only her
eyes, she is shod in comfortable slippers and lugs a large black bag.
She will
walk through this city’s poorest communities, visiting as many as 10 homes
everyday, helping to raise awareness and improve maternal and child health.
In her bag
is an assortment of medical supplies: Paracetamol tablets and oral rehydration
salts, bandages, condoms, contraceptive pills, iron and folic acid tablets, eye
ointments, and antiseptic lotion.
Solangi, the
sole breadwinner in her family of four, works as a lady health worker (LHW),
employed by the government’s National Programme for Family Planning and Primary
Health Care.
Launched in
1994, the programme now has a veritable army of 100,000 LHWs covering 60
percent of the population - the biggest outreach intervention in
These women
venture where few doctors dare to go, from congested cities to far-flung and
underdeveloped rural areas, acting as the link between communities and the
public health system.
Over the
years, their work has expanded to include health campaigns like administering
polio drops to children under five, plus neonatal tetanus, measles,
tuberculosis, and malaria control.
LHWs are
particularly important in the rural areas where three-quarters of Pakistan’s
population live, and where a trip to a health centre may require a hike of a
couple of hours to as much as a day. Illiteracy is widespread in these areas
and often customs prevent women from seeking health services without being
chaperoned by a male family member.
Solangi
cited the case of Zahida Sanghi, a woman Solangi’s age but already a mother of
seven. Sanghi lives in People’s Colony, a community in Larkana city in Sindh
province, some 322 kilometres from the southern port city of Karachi, which is
part of Solangi’s coverage area.
"Zahida
Sanghi was very weak and would not have survived another pregnancy. The husband
is jobless. It took close to two months to convince her mother-in-law that it
was all right for her to get a tubal ligation done since her family was
complete. This is all part of my job," she said.
Every day,
Solangi and her colleagues cover between five to 10 houses and talk to women
like Sanghi about the importance of antenatal check-ups, vaccinations, safe
delivery, the use and making of oral rehydration salts, and modern methods of
family planning.
They also
hold about eight group sessions each month where they discuss with local women
issues related to mother and child health.
Yet despite
the LHW programme, Pakistan remains a maternal and infant health hotspot.
The Pakistan
Demographic and Health Survey (PDHS), conducted from 2006 to 2007, shows an
infant mortality rate of 78 deaths per 1,000 live births. It also shows a
mortality rate of children under five years old of 94 deaths per 1,000 live
births. This means one in every 11 children born in Pakistan dies before
reaching his or her fifth birthday.
The maternal
mortality rate of 276 per 100,000 live births is also far too high, and has
remained virtually unchanged since 1991.
Sadiqa
Jaffery, president of the National Committee on Maternal and Neonatal Health,
said the statistics would be much worse without the LHWs on the ground.
"It’s
been established that where LHWs are present family planning services and
routine immunisation is better. The problem is that the coverage is not
blanket," Jaffery said.
But Farid
Midhet, founder of the Safe Motherhood Pakistan Alliance, remains unconvinced
of the impact of LHWs. "Family planning is the cornerstone of women’s
health services and it still eludes millions," he said.
Midhet cites
the 2007 PDHS, which says less than a third of married women use family
planning methods - only 14 percent use a modern temporary method, and less than
five percent receive their contraceptives from the LHWs. "The reason is
that many LHWs are only there on paper and rarely make visits or provide services,"
he said.
Midhet said
a more efficient way of reducing maternal mortality would be to bring primary
healthcare clinics closer to women, providing easy access to emergency
obstetric care through secondary hospitals, and providing affordable ambulance
services which could be called using mobile phones.
As for
reducing infant mortality, Midhet suggests improving mothers’ education,
promoting family planning, and making well-baby care available and accessible
to all, among other interventions.
He also proposed
providing prompt and effective treatment for diarrhoea and respiratory
infections among infants. "These services are of extremely poor quality in
public hospitals and people resort to the private sector, which is dominated by
quacks and is completely unregulated," Midhet said.
But Asif
Aslam of the U.N. Children’s Fund (UNICEF) pointed out that, "few doctors
and paramedics are willing to serve in facilities in the remote villages, and
less than 26 percent of people from the community venture to the government-run
health centres."
Jaffery said
despite their work, LHWs still do not enjoy their rightful status in the
community. "Their appreciation in the community is just not there,
salaries are not paid on time, if paid at all," she said.
Solangi said
it took her over five years to get accepted in People’s Colony. "Our work
holds no value for the community. It takes much perseverance and cajoling to
get into homes."