Introduction: Accepting the challenge to bring about positive and visible change in the health status of the country. Ministry of Health has initiated a comprehensive Primary Health Care Programme, which was launched in 1994.
The main thrust of the Programme is to extend the outreach services to the communities through selection and training of 100,000 lady health workers (LHWs) from all over the country. In a phase wise manner.
Today 96000 LHWs are rendering valuable services elevate the health standards of people with untiring dedication and compassion. Moving forward day by day, now the Programme has got the status of being the largest community based programme of Pakistan and also ranked amongst the revolutionary initiatives of the world in health sector.
-- To provide the preventive, curative and rehabilitative services to which the entire community has effective access.
-- To bring about community participation through creation of awareness, change of attitude, organisation and mobilisation of support.
-- To improve the utilisation of the health facilities by bridging the gap between the community and health services, through the LHWs.
-- To gradually integrate the existing health care delivery programmes like EPI, Malaria control, Nutrition, MCH within National Programme.
CONCEPT OF LHW:
The dynamic concept of LHW was introduced to bring about a silent revolution in ensuring quality healthcare to people especially to those living in rural areas. Under the Programme, women of the respective localities are trained as LHW to improve the health status of the people.
Having got the necessary training, a LHW visits the people at their homes and takes care of their health with quality healthcare and proper counselling to live a healthy life. As she belongs to their own areas, people especially women don't feel shy to share their health related problems and consequently get them cured. In this way LHW has been acting as an agent of change in improving national health indicators.
Initially, the Programme was launched in the rural areas. Keeping in view the prevailing health status of the country, the activities were also extended to the under served urban communities. However, considering the need of health services in rural areas, the Programme has recently been frozen in urban/semi urban areas, to increase coverage in rural areas.
At present, 96000 LHWs are deployed in the field. Their field activities are regularly monitored by the Lady Health Supervisors (LHS). One LHS is deputed to supervise about 20-25 LHWs of an area. LHS of rural areas are provided with the vehicle and driver whereas the LHS of urban areas are given fixed travelling allowance (FTA).
DURATION OF THE PROJECT:
The Programme was launched in April 1994. It was decided to deploy 100,000 LHWs across Pakistan by 2008 through a gradual process. The dynamism at top level, commitment of LHWs and active participation of community are doing the magic in meeting the target well before the set time.
Today 96,000 LHWs are on their way to distribute healthy smiles door to door and it is expected that by the end of December 2006, the target of 100,000 LHWs would be achieved successfully.
NATURE OF ACTIVITIES:
-- LHWs act as liaison between formal health system and community.
-- LHW disseminates health messages to the community on hygiene/sanitation and mother & child health.
-- LHWs register all the married women (15-49 years of age) of their area for motivation and counselling of family planning.
-- She provides contraceptive materials to their clients and essential drugs for treatment of minor ailments like diarrhea, malaria, acute respiratory tract infection, intestinal worms etc.
-- She co-ordinates with the EPI Programme to improve vaccination status of the women and children.
-- The main job of LHWs is to organise the community by developing women groups and Health committees in her area.
-- LHWs discuss with the community issues related with health, hygiene, nutrition, sanitation and family planning. They emphasis their relevance towards improved quality of life.
TARGETS - THE TARGETS YEARS FROM 1994 TO 2008:
Targets 1994 (Baseline) Status in 2003 Targets 2008
No of LHWs 0 70,205 100,000
No of LHW-Supervisors 0 2,000 4,000
Provision of Family Planning Services 5% 60% 80%
to Target Population
Contraceptive Prevalence Rate 11% 32% 45%
Population Growth Rate 2.9% 1.96% 1.5%
Infant Mortality Rate (Per 1000 live births) 105 77.1 55
Maternal Mortality Ratio (per 100,000 live births) 500 340 180
Crude Death Rate (Per 1000 population) 11 8 6
Crude Birth Rate (Per 1000 population) 41 28 22
RESOURCES OF THE PROGRAMME:
90% resources are allocated by GoP. In addition, International agencies like UNICEF, UNFPA, WHO, DFID and JICA etc are providing 10% financial assistance in form of contraceptives. In the new PC-1 for the period 2003-2008, an amount of Rs 21.5 billion would be required. An amount of Rs 23 billion has already been reflected in the Ten Year Perspective Plan of Planning Commission for the LHWs Programme by the year 2011.
Prime Minister of Pakistan has announced a remarkable increase in monthly stipend of LHW to 25%. It is a matter of great pride for us that the Programme has been rated as success by various national and international agencies. The results of recent evaluation carried out by Oxford Policy Management group (OPM). UK shows that most of the health indicators in the population covered by the LHWs are significantly better as compared to non-LHWs covered areas. LHWs are reaching at the doorsteps of the community and are providing primary health care services to them.
The national programme for FP & PHC has played a significant role in women empowerment by creating job opportunities to rural women by employing 96000 LHWs and around 3000 supervisors in the field. The third Evaluation Report showed that communities have shown confidence in LHWs and accepted them as preventive health care providers.
The LHWs working in the most remote areas of the country not only provide primary health care services at the doorsteps of the community but are also the source of inspiration for other women of their community. Thus, this Programme has upgraded the status of women in an underdeveloped and male dominated society.
SOME OF THE PROGRAMME ACHIEVEMENTS DURING THE LAST FEW YEARS:
-- Population coverage of the Programme increased from 30% (in 1999) to 65% by December 05.
-- Number of Lady Health Workers (LHWs) increased from 40,000 in 1999 to 96000. Number of Lady Health Supervisors (LHS) increased from 12000 in 1999 to 2300 in 2002.
-- Number of LHWs trainers increased from 8,000 to 10,000.
-- 11,000 VBFPWs of Ministry of Population Welfare have been absorbed and trained as LHWs in National Programme for FP & PHC.
-- There was a severe shortage of contraceptives and medicines in 1999. Now almost all supplies are available with sufficient stocks at all levels of the Programme.
-- 397 more vehicles have been added to the programme to improve quality of supervision. The total number of vehicles given to project is 1484; procurement of further 740 vehicles is in process.
-- As per evaluation, the Government of Pakistan incurs 90% of the expenditure on the Programme.
-- Stipend of LHWs was increased from Rs 1440/- per month to Rs 1800/- per month; whereas salary of LHS was increased from Rs 3000 per month to Rs 3900 per month with an annual increment of 30%.
-- LHWs were actively involved in Polio NIDs (Out of 30 million children, about 16 million were immunised by LHWs), MNT-SIAs (Out of 5 million target women, 4.5 millions were vaccinated by LHWs), DOTS, Nutrition, BDN activities, AFP surveillance and Safe Motherhood activities during the period 1999-2003. 20,000 LHWs were trained in giving EPI injections.
-- Extensive review of LHWs' and trainers' curriculum completed. Regular refresher courses for LHWs are being conducted.
-- According to the third evaluation of the Programme, a significant improvement is found in the health status of the population covered by LHWs as compared to non-LHW's covered population. More than 98% of LHWs met the selection criteria. They had significant contribution in reducing IMR, MMR and GR of the country.
-- Contraceptive Prevalence Rate (CPR) has increased from 24% to 35% in LHWs covered areas.
-- Activities started to extend the programme up to 2010-11. The strategic planning document has been prepared.