Lady Health Worker Program (LHWP)
The Lady Health Worker Program (LHWP) was established in 1994, with the goal of providing primary care services to underserved populations in rural and urban areas. In 2003, the national strategic plan set two goals:
(1) improving quality of services and
(2) expanding coverage of the LHWP through the deployment of 100,000 Lady Health Workers (LHWs) by 2005.
LHWs are deployed throughout all five provinces of Pakistan. These workers are attached to a local health facility, but they are primarily community based, working from their homes.
Training
LHWs are trained in classrooms for 3 months and then have 1 year of on-the-job training. This should include 1 week of training per month for a period of 12 months as well as 15 days of refresher training each year, although there is substantial variation in training patterns across provinces.
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Roles/responsibilities
The scope of services provided by LHWs has grown from an initial focus on MCH to include participation in large health campaigns, newborn care, community management of TB, and health education on HIV/AIDS. LHWs visit an average of 27 households a week, providing advice and conducting consultations with an average of 22 individuals each week.
Supervision
Supervision is highly organized and tiered in the Pakistani LHWP. LHWs are each attached to a public health clinic and are supervised on a monthly basis by an LHW Supervisor (LHS). LHWs should have community-based supervision at least once a month in which LHSs meet with clients and with the LHWs, review the LHWs’ work, and make a work plan for the next month.
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What is the historical context of Pakistan’s Community Health Worker Program?
Pakistan’s support for PHC dates back to the country’s signing of the 1978 Alma Ata Declaration. In 1993, Pakistan established the Prime Minister’s Program for Family Planning and Primary Health Care, which employed CHWs to provide PHC services in their communities. The program subsequently employed only female CHWs, and the LHWP was introduced in 1994. The goal of the program was to reach rural areas and urban slums with a set of essential PHC services, including promotive, preventive, and curative services; to improve patient-provider interactions; to facilitate timely access to services; to increase contraceptive uptake; and, ultimately, to reduce poverty. In 2000, the program was renamed the National Program for Family Planning and Primary Health Care, but it is still commonly called the Lady Health Worker Program (LHWP).