LHW Punjab and ICT Report - Oxford Policy Management

LADY HEALTH WORKER EVALUATION – PUNJAB AND ICT SURVEY REPORTInformation provided by LHWs confirms that curative services are an important partof their workload. Indeed, well over half of the cases seen by LHWs are curative rather thanpreventive. This might be due to LHWs being more likely to report a client who was ill thanto report the delivery of routine preventive services. Treating fever and respiratory infectionsand routine family planning visits were the most commonly reported activities.Table 2-1 Consulting the Lady Health Worker for Illness or Injury- by ProvinceMeasurePunjab& ICTSindh NWFP& FATABalochistanAJK& NAs% of individuals who were ill or injured in theprevious fourteen days who consulted theLHW –if they consulted anyone at all:20 13 18 18 32LHWs were also asked to report on the last emergency case seen – that is, the lastcase that they saw who required immediate referral to a health facility. Throughout thecountry, almost nineteen percent had never seen such a case. Presumably this reflects the useof other providers. For those who had seen an emergency case, complications of delivery andpregnancy, together with respiratory infections and severe dehydration, were the mostcommon. This suggests that LHWs are playing a useful role in the identification and referralof serious cases.ACTIVITIES IN THE COMMUNITYThe LHW is responsible for mobilising the community to promote and improve healththrough her participation in the health committee and in the women’s health committee.While across the country these committees are not taking off, there is a positive perception ofthe work of most LHWs. In Punjab and ICT, four out of five communities reported that theLHW has generally improved people’s life in the village and eighty-nine percent reportedthat once the women had become an LHW, she was usually respected.REFERRAL TO HEALTH FACILITIESOne objective of the LHWP was to improve the utilisation of public health facilities throughclient referrals. Private facilities are often not accessible in rural areas or are too expensivefor the poor to afford. Adequate publicly provided services that are either free or cheap at thepoint of delivery are therefore an important part of improving community health.Unfortunately, nation-wide, staffing and supplies at the health facilities that theLHWs are attached to are often very poor and some of the communities where LHWs workare under-served by vaccination services. 12 We found clinical support services on whichLHWs depend are inadequate which would limit the effectiveness of the LHWs referral role.12 See the Quantitative Survey Report for information on services at health facilities.8