It’s a moment of pride for Pakistan and democracy as our frontline spirited Lady Health Workers (LHWs) after a struggle of 18 years by standing up for their rights have their jobs finally regularized by all provinces. Benazir Bhutto Shaheed started the lady health worker’s program when she was the prime minister in 1994 and since then, these courageous women have been working yet protesting throughout for their rights. Heroes including (LHWs), Community Midwives (CMWs) and Vaccinators have been of great help to Pakistan in the fight to prevent child and maternal mortality in the country and because of them we can be able to achieve Millennium Development Goals (MDGs) 4 & 5. MDG 4 is about two third reductions in child mortality and MDG 5 is about three quarters reduction in maternal mortality ratio by 2015. Pakistan has lacked behind in the advancement towards achieving MDGs and sadly it has remained a challenge because here, according to a report by Save the Children 352,400 children under-5 die of preventable causes every year. The national under 5 mortality rate is 87 per 1000 live births and the maternal mortality rate is at an alarming 276 deaths per one 100,000 live births.
Regularizing the jobs of existing Lady Health Workers is an enormous step but the matter does not get solved here. There is a dire need to expand their numbers as currently they are 97,639 LHWs and 3,843 Lady Health Supervisors (LHSs) in the country covering only 60% of the population against the proposed target to increase this number to 130,000 by 2015 with a focus on expansion to marginalize and disadvantageous uncovered areas. The PPP’s government has the expansion of LHWs as a part of their party manifesto but till the 7th NFC Award (FY-2015) Lady Health Workers have been allocated Federal Government’s full funding for their salaries as already decided by the Council of Common Interests. After fiscal year 2015, it would become the responsibility of provincial governments to take the expense of their respective provinces due to the 18th Amendment. This has implicated the expansion by bringing a standstill situation to the program owing to lack of funds for meeting the operational cost of existing LHWs and barring the expansion. Likewise, any new creation of posts/appointments or future need will be financed by the provinces from their own budget/resources. This condition resulted in decrease in the number of LHWs instead of increasing their number i.e. in Punjab the number of LHWs decreased from 49,000 to 47,300 and similarly in other provinces.
The LHWs and vaccinators are not only playing a leading role in preventing thousands of preventable child deaths but are also our frontline force against the ongoing fight in the country for the eradication of polio. Unfortunately however, in the recent past we not only witnessed targeting of the LHWs and vaccinators by the terrorists but also a cold shoulder by the government towards resolving their issues. Some Civil Society Organizations like Save the Children have encouraged LHWs by arranging award ceremonies for them for the past two years.
Now that pre-budget meetings are happening, it is a reminder to the federal and provincial governments to allocate a portion of the budget for immunization, lady health workers and nutrition programs. This program has been a successful model replicated in different countries of the world and if gripped efficiently by Pakistan, we would be able to achieve MDGs 4&5. If these LHWs are provided with salaries by provincial government but they have no equipment, it would just be a waste of money and time. It is important to ensure that they are provided with the required stock of medicines and equipment, their terms of reference are reviewed and routine immunization is formally incorporated; they are trained to be able to provide mothers with skilled support to improve child feeding practices, including breastfeeding and to contribute in maternal and newborn care. The monitoring mechanisms should be strengthened as well to ensure effective utilization of this vital human resource. Similarly, the provincial governments should also take responsibility and start allocating resources for increase in the number of LHWs, CMWs and vaccinators in the respective provinces to be able to reach out to 100% population and achieve mother and child health related targets. Government is urged to fulfill their duty in providing security to these courageous women working day and night for the betterment of society.
Published in dailytimes on May 24th, 2014
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