Lady Health Workers Programme in Pakistan

World Health Organization (WHO) and UNICEF convened a conference in 1978 on Primary Health Care (PHC) at Alma Ata (USSR). During this gathering the governments of 134 countries as well as non-government stakeholders were brought together to reset the international health agenda. The Alma Ata declaration noted that PHC must, therefore, "evolve from the economic conditions and socio-cultural and political characteristics of the country and its communities."  Therefore the countries representatives to Alma Ata declaration considered to establish a community health workers programme with PHC approach. After this, PHC approach was seen as a mass production activity for training community health workers in several developing countries in 1980s. However, the conception and activities of community health workers have varied tremendously across developing and developed countries due to their aspirations and economic capacity.

Like other developing countries, Pakistan too had poor health indicators in terms of maternal and child health, during 1970s and 1980s. There was a lack of communication between the communities and the health system. Moreover, despite too little resources a major amount was being spent on tertiary care thus neglecting primary health care and the rural population. 

Ensuing the above facts and being a signatory to Alma Ata declaration, Government of Pakistan, also showed its commitment by launching a community health workers programme known as the "National Programme for Family Planning and Primary Health Care (FP&PHC)" in 1994 with support from WHO. This Programme was popularly known as "Lady Health Workers Programme" (LHWP), and it has been able to muster community participation through creation of awareness and bringing about changes in attitude regarding basic issues of health and family planning by establishing a comprehensive grass roots level effective system for provision of primary health care. 

A third party evaluation of this programme was undertaken in 2000-01 by an international firm (Oxford Policy Management) corroborating the strength of its implementation and the challenges to be addressed. At the same time different other studies, including internal assessment were also carried out on specific aspects of LHW work contributing to its development process. The purpose of these studies usually was to critically explore various aspects of the process to extract tangible implications for other similar situations. The specific objectives of these studies were: To assess the contribution of the LHWP in enhancing coverage and access of health care services as well as towards improvement of health indicators and to analyze various factors affecting the success and sustainability of large scale community based initiatives in developing country settings like Pakistan.