Underpaid, overworked and imperilled – the plight of lady health workers
Farhat Sultana, 40, has had stones and tennis balls hurled at her, wolf whistles blown by none other than the fathers whose children she vaccinated, even cheap one-liners like “humein katray kyun nahin pilati?” (Why don’t you administer the drops to us), followed by winks and guffaws.
Having risen to be a lady health supervisor (LHS), she is now area in-charge of the anti-polio campaign in Baldia Town and has been working with polio immunisation since 1994, when the programme started.
Had it not been for this brigade of 90,000 or so lady health workers and countless volunteers, whatever success Pakistan has witnessed today in bringing polio figures down so drastically would have been difficult.
With 56 cases recorded in 2012, Pakistan has made good progress, compared with 192 last year, according to the government. Globally, cases of death and paralysis from polio have been reduced from 350,000 in 1998 to less than 1,000 last year.
In the last quarter century, through global efforts the number of endemic countries from 120 has been reduced to just three – Pakistan, Afghanistan and Nigeria.
And so while these battalions of Pakistani field workers have met all kinds of abuses with dignity and grit (partly because most LHWs were given the ultimatum that if they did not cooperate their employment would be revoked), today, after six women have lost their lives, the question foremost on their minds is if the paltry sum they are being paid to eliminate the debilitating paediatric disease from this country is really worth it.
The killings may also have serious political ramifications for the multibillion-dollar global campaign. International donors, including the Bill and Melinda Gates Foundation, have been generously supporting these three-day campaigns aimed at some 35 million Pakistani children younger than five, employing 225,000 health workers.
These volunteers, belonging to the area, are paid Rs 1,000 for the three-days to cover from 100 to 150 houses a day. Their supervisors are paid Rs 3,000.
“But it is actually more than three days as they are given a one-day refresher/training a week before the campaign begins,” said Sultana, who supervises teams in Baldia Town.
These trainings include teaching the field workers how to interact with parents, warding off unsavoury elements and behaviour, tackling refusals, and then filling up the pro-forma so that they can provide the field information accurately to their respective area in-charge.
But, according to Nasim Munir, president of the Karachi chapter of the All Pakistan Lady Health Workers Association, these workers do more than their share of work.
“Our field workers do the work of the communications officers and the social mobilisers hired by Unicef and WHO,” said Munir who has been working on polio edatication for the last 13 years.
This grouse was echoed by quite a few government-employed LHWs and the lady health supervisors (LHS).
“They are supposed to handle refusals by motivating parents who are not convinced, distribute posters and pamphlets before the campaign begins, talk to clerics of the mosques. Instead, all these tasks are lugged on to the field workers because they are from the area, know the language, are familiar with the culture and sentiments of the people and they have direct access to their homes,” explained Munir.
“Why can’t our women get the kind of high salaries and perks that these people get who have been hired by international agencies?”
According to the LHWs, the three days usually extend to five or more and they are not paid anything extra and the 9-to-5 working hours are extended as well. “Those who have been missed, the teams have to go again, sometimes three or four times, until the job is done.
At times, in a place like Karachi, where there are many high-rises, like Gulshan Town which has over 4,000 multi-storey buildings rises, the work gets all the more gruelling. “They climb six, seven or even more floors only to be told the child is sleeping, or the child is unwell or the mother is busy and they could try another time, with no consideration whatsoever, the inconvenience caused to the team.”
With the recent attacks, however, these problems have taken a backseat and safety has become their top priority.
“Can they provide us with security?” asks Sultana. She has her reservations.
Nasim Munir said: “They were providing security in Gadap Town after the incident in July but clearly it was not enough or those providing security were not doing their job as Omar Farooq, one of the polio field workers, from that area was shot dead on December 17.”
According to the health workers, it is impossible to provide security to each and every team, given the dearth of security forces in Karachi alone and the personnel that are available are deployed for influential people with clout and politicians of the city.
Munir suggests reverting back to the old ways of holding camps. “Police cannot help us, and there are not enough rangers to accompany each and every one of our team. In fact, they are as much a target. So the only solution is to set up camps where parents can bring their children like it was done in the good old days. At least it would then be easier for the law enforcing agencies to manage the security issue somewhat.”
Dr Samrina Hashmi, president of the Pakistan Medical Association’s Sindh chapter, explained that the door-to-door measures were taken precisely because parents were not bringing their children to the EPI (Expanded Programme on Immunisation) centres to get them vaccinated. However, she thinks if the vaccine has to be taken to the children, and because it would be impossible to provide security to each team, perhaps they could be accompanied by local clerics or even the local doctors, both of whom are held in high esteem.
“But if that is not possible anymore, perhaps more centres in schools, mosques and clinics can be set up where these drops are administered,” she said.
However, Dr Shahnaz Wazir Ali, adviser on polio to Prime Minister Raja Pervez Ashraf said categorically that “stationery approach alone” will not be effective as the idea is to get every child immunised.
The PM’s adviser conceded that the killing was a set-back to the campaign but it should not deter the health workers just when the goal of the “endgame” was so close. “The provincial government will need to take stock of the situation and revisit the campaign,” she said, adding that the centre would back it fully.
“The Punjab government went right ahead as schedule and completed its three-days of campaign; they increased the security for the workers as did the Khyber Pakhtunkhwa in some parts of the province,” pointed out Wazir Ali.
The author is a freelance journalist.