As numbers continue to rise at an exponential rate in Pakistan, fears and anxieties among the population are heightened, not just fearful of the spread, but fearful that the health care system will collapse, given the already limited, dilapidated infrastructure and resources attempting to serve the massive population. With limited human resources within larger facilities, and reflecting on previous strategies, one begins to wonder whether the government would loop in Lady Health Workers [LHWs} all over Pakistan, to assist in delivering care to those infected by COVID-19 in the underserved areas.
The LHWs work as community agents of change, employed in underserved and hard to reach areas, going door to door providing integrated preventative and curative health services. Being members of their communities, the theory behind this was to leverage their “peer status”, encouraging relationships and trust of the system and services. Initially meant to provide primary health care for women and children in rural and underserved areas, LHWs have also been employed to run vaccination campaigns, hold district health meetings in communities, and act as a referral mechanism for those seeking health services. Additionally, they have been engaged in family planning initiatives, being trusted members of the community, with the ability to make door-to-door visits. Currently, 100,000 LHWs are deployed across Pakistan, serving approximately 60% of the population.
All of this however, has come with a price. The communities that they serve are generally low income areas, in patriarchal environments, thus their relationship building with women and encouragement of use of contraception for instance, is seen as a threat. LHWs face constant verbal, physical and social threats, while also being underpaid, and under resourced. Without being supplied any personal protection equipment or formal training for self protection, LHWs are expected to provide extensive services amidst all forms of threats and adversity, in their communities.
The threat of COVID-19 is real; it is also clear that social distancing has been declared as the needed action for prevention. While public gatherings and non-essential visits are banned, it is unclear as to whether this includes the home visits and community meetings held by the LHWs. If the government chooses to loop in LHWs into health service provision, one wonders if they would be provided with the required equipment and protections needed to secure themselves, given that healthcare providers in facilities have been dealing with shortage of equipment. Even if not looped in, if LHWs are expected to continue their visits, they will still be requiring PPE, and there is uncertainty of this consideration.
Thus, the government’s silence, and no acknowledgement of LHWs in the National Action Plan for COVID, is concerning. There is no clarity whether these operations have been halted, and if there is any intention of provision of safety for these workers. These women are already at risk, and given the prevailing conditions, more so now, both to themselves and their communities as potential carriers. It is imperative for the health departments to take note of this, and to act fast.