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WHEN a community healthcare worker in Pakistan leaves her home armed with a medical kit, she may have stepped on the frontline of a dangerous war in which extremists stand opposed to polio vaccination campaigns.
While the Lady Health Worker programme progressed as a successful primary healthcare model, many of its members have now become a target for the Taliban who oppose the polio vaccine for political reasons as well as demonise it as a Western ploy to sterilise children. The systematic killing of LHWs, key to Pakistan’s immunisation programme, threatens not only the polio eradication drive, but forces community workers away from delivering primary healthcare and other immunisation services.
There was no public outrage and no vociferous political condemnation when Salma Farooqi, a community health worker and mother of five in Peshawar was kidnapped, brutally tortured and shot recently because she was participating in a three-month anti-polio drive in KP.
Hardly surprising then is the general lack of recognition for LHWs who work under life-threatening conditions as inoculators and are thus responsible for reducing the burden of disease. Earning a pittance, around $2.50 per day, and with few career prospects, many like Salma are compelled to work in high-risk districts, where even policemen are hesitant to accompany them.
Around half the reported polio cases in Pakistan originate from conservative tribal areas because either families fear Taliban reprisals if they fail to resist vaccination drives or are influenced by the militants’ narrative.
Over two decades, community health workers have brought healthcare into people’s homes, helping to reduce maternal and child mortality, advocated effective family planning and communicated awareness to lower the incidence of preventable diseases.
In many ways, LHWs are a significant cog in the wheel because of their outreach and local acceptance that enables home visits and operating out of a health house (clinic within the home) where women are educated in hygiene, immunisation, nutrition and family planning.
For this job they must have continuous access to training and healthcare resources. Empowering women workers otherwise unable to work through proper employment — because of minimum opportunities and patriarchal traditions — is actually progress with a green signal.
Initiated in 1994 by Benazir Bhutto and implemented by the health ministry, the LHW programme is focused on family planning and primary health services but has since expanded to include immunisation drives and related health-awareness campaigns.
Medical experts endorse the success of this all-woman trained workforce of 110,000.
Documenting its effectiveness, a study found that the programme had expanded to serve more disadvantaged populations, but that communities in greater numbers required healthcare access. Recommending its scope and impact, doctors explain this cadre should be further expanded because the programme assists only 60pc of the population. Adopting legislation to protect and define the role of community health workers lends legitimacy and acceptance.
Recently the implementation of the Punjab Reproductive, Maternal, Neonatal and Child Health Authority Bill 2014 led to the decision to regularise the services of 48,000 LHWs after a long protest and hunger strike.
Although isolated areas would benefit from the kind of services provided, poor security measures and conservative thinking among male community leaders makes LHWs job dangerous. Studies have also found that they suffer occupational stress because of irregular and inadequate salaries and travelling long distances for work.
Inconsistent medical supplies, lack of a career structure and difficulties in communicating effectively with the families are additional challenges. Monitored by provincial and district coordinators, one health worker visits about 200 houses every month; and talks to around 1,000 people, all the while working with a local government health facility for training and medical supplies.
Developing a similar programme for male health workers aimed at targeted populations with incentives for clinical training would augment primary healthcare provision.
WHO has identified Peshawar as the “largest reservoir of endemic polio virus in the world” but migrations, and with them the spread of the poliovirus and enhanced threat to vaccinators, means other provinces too should take on security responsibilities and render them effectively. Responsibility for future generations and the task of improving vulnerable lives drives Pakistan’s women health workers to square up to the threats that their job involves.
The writer is a journalist.
