LAHORE/KARACHI/PESHAWAR:
For the average low-income girl who rushed into marriage with minimal knowledge of contraception, pregnancy, and the complexities of childbirth, a health worker’s door-to-door visits were literally nothing less than a lifeline. However, like all good things, welfare initiatives also come to an end quite soon in Pakistan.
In 1994, the government launched the Health Workers Program, with the goal of improving maternal and child health outcomes. Each VST was responsible for providing home consultations on family planning, prenatal care, childbirth, and postnatal stages of the newborn to nearly 1,000 to 1,500 married women in their community.
However, after the Covid-19 outbreak, the government started using LHW services for coronavirus, measles, typhoid, pneumonia and polio vaccination campaigns and dengue awareness activities, depriving thus providing pregnant women and their fetuses with specialized medical care and exposing them. to multiple health complications.
Sakina Bibi, a villager from the suburbs of Lahore, recounted the tragic loss of her grandson due to birth complications. “Since our village lacks medical facilities, the health worker was our savior. During the early days of my daughter’s pregnancy, she visited us regularly. However, over time, her visits became infrequent and her guidance limited. After seven months, my My daughter was stillborn prematurely,” Sakina sadly shared.
A similar case occurred in southern Sindh, where low-income women of reproductive age had to face gaps in healthcare provision as 24,000 HCWs were distracted from their obstetric duties and assigned to vaccinate children during eight days a month. Currently, there are 3,000 male health workers and more than 400 female health supervisors deployed in Karachi.
In this regard, Halima Laghari Zulqarnain, central president of Sindh Health Employees Association and Pakistan Community Health Workers Federation, told The Express PAkGazette that the provincial health department was providing treatment of stepmother to health workers.
“It is not the job of female health workers to vaccinate children. The main task of the LHW is to provide basic health services to newborns and pregnant women in rural areas. However, instead of facilitating the workers’ real work , the government redirected them towards other campaigns,” Zulqarnain lamented.
The plight of LHWs was equally deplorable in Khyber-Pakhtunkhwa (KP), which remains one of the most unfortunate provinces of Pakistan, where maternal and child health remains alarmingly neglected. Despite the government’s claims to improve healthcare, thousands of mothers continue to die in childbirth each year, while even more newborns say goodbye to the world long before they can celebrate their first birthday.
Ayesha Khan, president of the Health Workers Association, revealed that LHWs once played a pivotal role in community healthcare as they knew all the mothers and children in their assigned areas, provided timely advice and ensured care. prenatal. “They were a key force in population control, but systematic neglect has undermined their effectiveness. Furthermore, many health worker positions remain vacant, exacerbating the crisis,” he reported, adding that the focus on eradicating the Polio had overshadowed broader health challenges.
“Ignoring health care workers could have long-term repercussions as the province continues to grapple with high rates of maternal and infant mortality,” he predicted.
According to the Pakistan Demographic and Health Survey, 1,900 mothers die annually in KP due to childbirth-related complications. However, proper use of contraceptives could save up to 800 lives each year. Similarly, the infant mortality rate is 53 deaths per 1,000 live births, but timely family planning could prevent 16,700 infant deaths per year.
Dr Sadia Usman, a gynecologist, opined that early marriages and lack of effective prenatal counseling were the main factors leading to infant and maternal mortality. “Most maternal and child deaths occur in rural areas where health workers take full responsibility. When a FSW is hired in another job, she is distracted from her primary duty. Almost 90 percent of all deaths among women ages 15 to 45 are due to preventable medical complications, such as high blood pressure or postpartum hemorrhage,” said Dr. Usman.
According to information obtained by The Express PAkGazette, more than 250 women and 15,000 children die during every 100,000 births in Pakistan; Punjab contributes 31 percent of the deaths and Azad Kashmir and Gilgit-Baltistan report 69 percent of all deaths.
Dr Naveed Akbar Hotiana, pediatrician at Ganga Ram Hospital and Fatima Jinnah Medical University, confirmed that ventilators, modern incubators and other facilities needed for premature babies were lacking in remote areas. “When a newborn arrives at a tertiary health center, a long time has already passed. For this reason, there has been an increase in the mortality rate of newborns. If female health workers become more active, the mortality rate motherhood and childhood can be significantly reduced,” said Dr. Hotiana.
Sharing LHW’s side of the story, Rukhsana Bibi, a healthcare worker, expressed the difficulties she faced in her job after the government hired her for other services. “Sometimes we were assigned tasks for dengue and polio campaigns and other times we were included in pneumonia, measles and Covid-19 teams. After all this, we also have to visit women door to door and advise them on their reproductive problems. ” lamented Rukhsana, who protested her low salary and heavy workload.
“Healthcare workers are overburdened with multiple responsibilities and their salaries are delayed for months. Furthermore, the government has not implemented a service structure or increased their salary in the budget,” Khan confirmed.
On the other hand, female healthcare workers in Balochistan occupy the lowest rung of the province’s overburdened healthcare system. They are mostly poorly paid, have precarious contracts and are hostile in many neighborhoods, where going door-to-door is often a risky ordeal due to the imminent threat of violence. In fact, several TSLs have been targeted over the years, making their already difficult job even more dangerous.
In 2014, four polio vaccinators were killed during a militant attack in Balochistan, three of whom were female healthcare workers. However, security concerns are not limited to the southwestern province, as health workers in Sindh face similar risks while carrying out their duties during campaigns against polio and other diseases.
“A social worker was raped during an anti-polio campaign in Jacobabad two months ago, which is why our association also protested,” Zulqarnain revealed.
Dr Khizar Hayat, provincial coordinator of the Maternal, Newborn and Child Health (MNCH) Programme, acknowledged the challenges of the programme, but insisted on the government’s commitment to reviving it. “New HCWs are being recruited in Kohat, and soon other districts will also see an increase in their numbers. Their duties include tasks assigned by the government, be it anti-polio or other campaigns. We have collective goals to achieve,” said the Dr. Hayat, speaking about the province which currently has 17,000 healthcare workers.
Addressing the complaints, a spokesperson for the Punjab Health Department confirmed that from 2019 to 2023, several additional duties had been assigned to female healthcare workers. “At that time the staff was smaller, however, today there are separate staff for each campaign and the burden on the TSL is less,” they responded. With additional information from our correspondent in Quetta
