LADY HEALTH WORKERS IN PAKISTAN: TRACING PERSONAL AND PROFESSIONAL TRAJECTORIES WITHIN A PATRIARCHAL CONTEXT

Abstract

In Pakistan, the Lady Health Workers (LHWs) a cadre of Community Health Workers (CHWs) are providing health services to communities in rural areas and disadvantaged urban area since 1994. Introduced to enhance women‟s access to PHC, they countered gender barriers of segregation and restrictions on the mobility of women. Currently 100,000 LHWs are deployed in the country. The LHW have been granted the status of regular government employees recently following nationwide campaign including protests. Generally the interest in the LHWs has been largely confined to monitoring and evaluation of their activities. The perspectives of LHWs as a female workforce on the margins of formal health system within a patriarchal context, has never been explored. This qualitative study was designed with the aim to explore and describe how the experiences of the LHWs shape the process of their development as female health workers in the Pakistani health system. The three objectives of the study were to explore how the LHWs‟ life and work experiences influenced their development as health workers, to examine the process by which LHWs constructed and defined their personhood and to understand how community- and workplace-based gender dynamics influenced the LHWs in the Pakistani health system. This qualitative study was carried out two in four union councils of a district in Pakistan. It involved 32 indepth interviews conducted with 27 LHWs, while six FGDs were conducted with this cadre of women. Interviews were also conducted with other health professionals including eight health managers, two medical assistants, two Lady Health Visitors (LHVs), three Lady Health Supervisors (LHSs) and three Vaccinators. The results showed that both community and health system were important contexts for the LHWs‟ socialisation and formation of professional identity. The transitions, turning points and trajectories of the LHWs show that the LHWs have used their agency to make the best use of available resources and are proud of their achievements. The analysis of findings gave useful insights about the practices which led to the development of identity through professional socialisation process. Gender was pervasive in all spheres of personal and professional lives of the LHWs, and lack of health system support such as referral rendered the LHWs‟ services ineffective. The LHWs attributed community health improvement to their contributions, and identified with the government health team after regularisation.