title: Lady health workers programme in Pakistan: challenges, achievements and the way forward.
abstract: OBJECTIVE
  To review the Lady Health Workers programme and critically explore various aspects of the process to extract tangible implications for other similar situations.
  
  
  METHODS
  A descriptive study was carried out over a period of one year (2007-08). A detailed desk review of project documents, interaction with relevant stakeholders, performance validation and extensive feedback from the community were collected. The data so obtained was analyzed and evaluated against predetermined benchmarks.
  
  
  RESULTS
  Each LHW serves a population of 1,000 people in the community and extends her services in the catchment population through monthly home visits. The scope of work includes over 20 tasks covering all aspects of maternal, newborn and child care. Total cost incurred on each worker is averaged at PKR 44,000 (US $ 570) per anum.Almost 60% of the total population of Pakistan, mostly rural, is covered by the programme with more than 90,000 LHWs allover the country. The health indicators are significantly better than the national average, in the areas served by the LHWs.
  
  
  CONCLUSIONS
  The LHW programme has led to a development of a very well placed cader that links first level care facilities to the community thus improving the delivery of primary health care services. However, despite its success and the trust it has earned from the community, there are certain areas which need special attention which include poor support from sub-optimal functional health facilities, financial constraints and political interference leading to management issues. The future carries a number of challenges for management of the programme which have been highlighted.
authors.affiliation: Health Services Academy, Federal Ministry of Health, Govt of Pakistan.
authors.forename: Assad
authors.initials: A
authors.lastname: Hafeez
authors.forename: Bile Khalif
authors.initials: BK
authors.lastname: Mohamud
authors.forename: Mobasher Riaz
authors.initials: MR
authors.lastname: Shiekh
authors.forename: Syed Ayyaz Imran
authors.initials: SA
authors.lastname: Shah
authors.forename: Rashid
authors.initials: R
authors.lastname: Jooma
mesh_terms: D000124:Achievement; D003150:Community Health Workers; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008430:Maternal-Child Health Centers; D010154:Pakistan; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D000078329:Workforce