title: Perceived individual and community barriers in the provision of family planning services by lady health workers in Tehsil Gujar Khan.
abstract: OBJECTIVE
  To identify contextual barriers (social, cultural, geographic and economic), faced by Lady Health Workers (LHWs) and to assess their strategies at different levels (individual, community and system) in the provision of family planning services to their clients in Tehsil Gujar Khan.
  
  
  METHODS
  The mixed model cross-sectional study was conducted from April 1 to July 10, 2010, in Tehsil Gujar Khan, Punbjab, Pakistan. It was carried out in two phases: in the first phase 10 in-depth interviews were conducted with the workers, followed by two focus group discussions. On the basis of findings, a structured questionnaire was developed and administered to 111 workers in the second phase. Of the total, 97 responses were used for analysis. Data analysis was done by SPSS-16.
  
  
  RESULTS
  Majority of the respondents reported barriers at the community level: religious barriers 69% (n = 67), sociocultural barriers 58% (n = 56), transport 54% (n = 52), communication and economic reasons 25% (n = 24). Individual level barriers were female gender, experience and low education. System-level barriers were increased workload, National immunization days/sub-national immunization days, late supply, stock shortage (especially injectables), problems for referred clients and lack of proper incentives.
  
  
  CONCLUSIONS
  Lady health workers still face barriers at individual, family, community and system level in the delivery of Family Planning services.
authors.affiliation: Federal Government Polyclinic (PGMI), Ministry of Health, Islamabad, Pakistan. khanzadaamc@yahoo.com
authors.forename: Abdul Wali
authors.initials: AW
authors.lastname: Khan
authors.forename: Chaudhry Muhammad
authors.initials: CM
authors.lastname: Amjad
authors.forename: Assad
authors.initials: A
authors.lastname: Hafeez
authors.forename: Rehan
authors.initials: R
authors.lastname: Shareef
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000523:psychology*; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006792:House Calls; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010154:Pakistan; D011787:Quality of Health Care; D000078329:Workforce