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This was in collaboration with the Workers Research Organisation (WERO). The reports reveal the depths of physical, psychological and economic assaults on Lady Health Workers (LHWs) and the need to change this despicable situation.
The Lady Health Workers (LHW) programme was established by the Pakistani government in 1994 to bridge the yawning gaps in delivering primary health services in rural and slum urban areas. It is also aimed at empowering women as LHWs and as recipients of the essential services they provide.
The LHWs role in improving maternal and child health care over the last 23 years can hardly be overemphasized. As Rosa Pavanelli, the PSI General Secretary observes:
The LHWs are heroines. Poorly remunerated and often having to travel quite some distance, they have been a source of joy for millions of people in Pakistan. Particularly women and children. Coordinating with traditional birth attendants and midwives, they have been very important in ensuring adequate care is received by mothers, and other women.
The work being done by these women community health workers has contributed significantly to the improvement in health outcomes in the country. For example, under-five mortality has been reduced from 138 before the LHWs scheme commenced to 86 deaths per 1,000 live births. Maternal mortality has also fallen from 490 to 260 deaths per 100,000 live births within the same period.
It is very unfortunate that they face sexual harassment at work and on the field. This has to stop. They have to be properly remunerated and be protected from gender-based violence. Their dignity has to be defended, within a context of decent work. Respect for their rights will equally lead to enhanced health care delivery by the LHWs and consequently accelerate the march of Pakistan towards universal health care and fulfilment of the Sustainable Development Goals.
There are over 100,000 LHWs. They pass through a 15-month training programme after a minimum of eight years formal schooling, and the possession of a Middle School Pass. The first three months comprise classroom instruction and practical learning. They then go through practical on-the-job training, during which they spend one day each month in the classroom to work on problem-based modules. Each LHW provides health services for not less than 1,000 persons. They are also change agents in their communities, carrying out door-to-door health education for behavioural change.
The findings of the study on “Sexual harassment with Lady Health Workers at office and field” however shows that LHWs face violence and sexual assault during work as well as during training. They also face insults and denigration based on patriarchal prejudices. These have led to brutal murders of LHWs, in a number of cases. According to the report of the research 22 LHWs were killed in 2012 alone.
The study on “Socio-economic impacts of delayed wages on Lady Health Workers and their families” also shows the need for their remuneration to be payed when due, as well as the gross inadequacy of what they earn. It was found that the average LHW is constantly indebted to local retailers to be able to feed herself and family members.
A significant proportion of the LHWs are the bread winners in their families. “In 63% of the households surveyed, men – sons or husbands of working age- do not earn anything”. Interestingly they are also purveyors of the patriarchal suppression of LHWs rights, with 87% of the LHWs interviewed informing that “they have no control over their salaries, which leads to depression”.
This depressing situation is intolerable for any group of workers. It is particularly deplorable when it is being made the lot of a crop of women at the fore of providing primary health care in such a novel manner. “As one of the largest community health worker (CHW) programmes in the world, the LHWP offers important lessons and may represent a replicable model to the global community”.
It is thus pertinent for the global community to call for action against the conditions of Lady Health Workers in Pakistan now. PSI supports the recommendations of the studies for: a new salary structure commensurate with the educational qualifications and work done by LHWs, and; the conduct of a widespread awareness campaign on the implementation of “The Protection against Harassment of Women at Workplace Act, 2010”, by the Pakistani government and civil society movement.
PSI will continue to support the robust self-organising efforts of LHWs, including capacity-building for effective collective bargaining and the formulation of protocols aimed at stopping violence at the workplace and during the LHW training programme. The time has come to stop violence against LHWs and fight for decent work and the upholding of their dignity.