Challenges facing lady health workers around the world: Maternal and child health crisis

Around the world, lady health workers (LHWs) have long been essential to improving maternal and child health, especially in rural areas where medical facilities are lacking. However, due to changing priorities in healthcare systems, especially in the wake of the COVID-19 pandemic, the invaluable role of these health workers is now at risk. Originally launched in 1994, the LHW program aimed to provide home health care to underserved communities, focusing on family planning, prenatal care, and childbirth. But the pandemic has diverted LHWs from their core duties, resulting in unintended consequences for pregnant women and children across the country.

                                                           

The vital role of LHWs

The LHW program was designed to provide essential health services to women in underserved areas. Each LHW was responsible for providing guidance on family planning, maternal health, and newborn care to 1,000 to 1,500 women in their communities. These health workers were not only a lifeline for pregnant women but also a vital part of efforts to reduce maternal and child mortality rates, which are alarmingly high in many parts of the world.

For example, on the outskirts of Lahore, Sakina Bibi, a villager, recalls how LHWs played a crucial role in overseeing her daughter’s pregnancy. “There is a lack of medical facilities in our village, and the lady health worker was our savior. She used to visit us regularly, but as time passed, her visits became less frequent. After seven months, my daughter gave birth prematurely,” says Sakina. The story reflects the growing concern that the changing focus of the healthcare system has put women’s lives at risk.

                                                            

Shift in focus: COVID-19 and other campaigns

The COVID-19 pandemic has further exacerbated the challenges faced by LHWs. In response to the outbreak, the government redirected LHWs to vaccination campaigns not only for COVID-19 but also for measles, polio, pneumonia and typhoid. While these campaigns are undoubtedly important, the diversion of LHWs from their primary responsibilities in maternal and child health has left pregnant women and newborns without the care they need.

Workers and Employees Association President Sindh Lady Health Halima Leghari Zulqarnain criticized the change and stressed that LHWs should focus on maternity and childcare instead of being overburdened with vaccination tasks. “It is not the job of lady health workers to vaccinate children. Their primary responsibility is to provide health care to newborns and pregnant women. The government has failed to prioritize this,” he lamented.

                                                                   

Situation in Khyber Pakhtunkhwa and Sindh

The neglect of maternal and child health is particularly evident in Khyber Pakhtunkhwa (KP) and Sindh. In K-P, where maternal and child health has historically been neglected, LHWs once played a key role in reducing maternal and child mortality by providing antenatal care and family planning services. However, Ayesha Khan, president of the Lady Health Workers Association in K-P, pointed out that systematic neglect has undermined their effectiveness. “Many LHW posts are vacant, and the focus on polio eradication has overshadowed broader health challenges,” she said.

Reassigning nearly 24,000 LHWs to vaccination duty in Sindh Health care delivery has declined significantly. Currently, only 3,000 LHWs are available to provide essential maternal health care, which is far from what is needed. The lack of consistent health care support is harming pregnant women. Dr. Sadia Usman, a gynecologist, explained that early marriages and lack of prenatal care play a major role in maternal and child mortality in rural areas.

                                                            

A fundamental health crisis

Health statistics paint a grim picture. In K-P alone, 1,900 mothers die annually from complications related to childbirth, and the proper use of contraceptives could save 800 lives each year. The infant mortality rate is also very high, with 53 deaths per 1,000 live births, and timely family planning could prevent 16,700 child deaths annually. However, without adequate support for LHWs, these numbers are unlikely to improve.

Pediatrician Dr. Naveed Akbar Hotiana highlighted the lack of essential medical equipment in remote areas, especially for premature babies. “By the time a newborn is brought to a tertiary health center, it is often too late. If LHWs were better equipped and more active, we could have reduced the maternal and neonatal mortality rate.”

The Struggle of Lady Health Workers

The situation for LHWs is equally dire. Rukhsana Bibi, an LHW, expressed frustration about the additional responsibilities placed on her. “Sometimes we are assigned to dengue or polio campaigns, and other times, we are part of COVID-19 teams. After all this, we still have to meet women and counsel them on reproductive health.” Rukhsanana and other LHWs face delays in salaries, a lack of a clear service structure, and a heavy workload that often leads to burnout.

In Balochistan, LHWs are particularly vulnerable, as they work in some of the most dangerous and underfunded areas of the country. Many are poorly paid, employed on irregular contracts, and face hostility in some areas. Sadly, some LHWs have also been subjected to violent attacks. In 2014, four polio vaccinators, including three LHWs, were killed in Baluchistan, highlighting the dangers these workers face.

                                                    

Government response and future outlook

Despite these challenges, government officials are trying to address the issue. Dr. Khizar Hayat, Provincial Coordinator for Maternal, Newborn and Child Health (MNCH) in K-P, assured that new LHWs are being recruited, and efforts are underway to revive the program. Similarly, the health department in Punjab acknowledged the burden placed on LHWs and assured that there is now a separate staff for each campaign, which will reduce the pressure on workers.

However, many experts believe that these measures are insufficient to address the wider maternal and child health crisis in the world. Health systems need to refocus on supporting LHWs and ensure that their vital role in maternal health care is not overlooked.

                                                             

Conclusion

The role of lady health workers in the world’s health care systems is more important than ever, especially in addressing the maternal and child health crisis in rural and underserved communities. However, changing priorities and lack of support have left these workers with an excessive burden and resources. If the government fails to prioritize the LHW program and ensure that these health workers can fulfill their essential responsibilities, the world's already high maternal and child mortality rates will remain unchanged, with devastating consequences for families across the country.