Abstract

This study is an attempt to find out the difficulties or challenges that are faced by L.H.W (Lady Health Workers) in Tehsil Kallar Syedan. In domestic healthcare, these health workers provide basic nursing care in rural and urban communities. Lady health workers face issues in providing domestic health care services. They promote a hygienic environment. The main aim of the study is to know about the problems of L.H.W and their duties as well as to identify the reasons or the causes of emerging issues for lady health workers. This study included 10 participants and took 3 months to complete. It was conducted in Tehsil Kallar Syedan. The study used a qualitative research design and an explanatory method to understand the challenges of the L.H.W. Sample drawn by purposive sampling and an in-depth interview method was used as a tool for data collection. For this study, thematic analysis was used to analyze the collected data.

Key Words

L.H.W, Domestic Health Services, Polio, Mother and Child's Health, CMWs, Family Planning 

Introduction

Lady health workers play a significant role between people and those domestic healthcare services that are provided by the government according to the Journal of Medical Internet Research 2020. Their job is to create awareness about health and family but they face challenges to convey their message. Their duty requirement is to go door to door for service provision but it becomes very challenging due to certain hurdles. They are aware people of health especially maternal and child health. They help people with the burden of child mortality, and malaria and work to decrease the ratio of Polio. Developing countries like Pakistan, face major issues regarding Polio duty. It is about more than a decade, Pakistan has been working with female health workers for domestic health care as discussed in the 2011 research paper. They are mostly working under their supervision. Pakistan is very bad in terms of maternal health and the health of children. It is because of a lack of connection or communication between people and the provider of domestic health care services. Sometimes the population of rural areas is neglected by the government. For the solution of this issue Pakistan made a program with the help of WHO. In 1978, a program was done at Alma Ata by WHO. In this program, Pakistan hired lady health workers who were responsible for domestic health care. They gave awareness to people about very basic problems and family planning. This was done on grass root level. This system was very effective for the society especially for those people who were living in rural areas. Lady health workers help people a lot. Their program has a great effect on the rate of mortality according to the 2011 Mount Sinai Journal of Medicine.

In this paper, we will discuss the challenges that are faced by lady health workers. Sometimes people use harsh language in front of them. Some people can't even listen to them. This is one of the major issues. Another problem is that they have a very tough schedule. They don't even have time for their families. They have to do their jobs in the rain. They are bound by their duties. They have to cover a large range of areas. For this, they need a helper. If work is divided between lady health workers and their helpers, then it is easy to perform. Sometimes people are not willing to discuss their personal matters. They feel hesitation to discuss family planning. People make bad comments about them. Sometimes they are rude to lady health workers. Sometimes people even think that lady health workers sell medicine that is provided by the government. People demand those medicines that the government does not provide. Some people don't give permission to their women or families to meet with lady health workers. Some are not ready to give Polio vaccination to their newborns. They think this is not a good vaccine. They have their own belief related to Polio. Lady health workers not only face problems related to their timetable but also to the population where they are working. This is a major issue. The government needs to solve these types of problems. Government should make policies for them and these policies should be implemented.

The main purpose of the study is to know about the problems of L.H.W and their duties. What problems do they face and what is the impact of schedule?

 Another objective is to identify the reasons that cause issues for lady health workers. What are the main elements that create issues for them? 

Review of Literature

In 2017, E. Sarin and S. Lundsford worked on a community health worker program that facilitate maternal child health. They used interview methods. These 3 factors; One is about behavior and action. The second is about challenging factors. The third is about how a person responds. In 2020, B. William and his team members worked on Women working in different fields related to health. They face issues including unequal pay distribution, poor environment, and poor behavior in the workplace., Identify questions, select the study, chart data, summarize and result report, and consult with experts. There are 3 findings; Identify the responsibilities of the family, the environment at the workplace, and stereotypes. In 2021, Shahbaz and his team members worked on the experiences of female physicians. They faced mental stress. They used Empirical phenomenological methodology and semi-structured telephonic-based interviews. Females faced emotional and psychological issues. Many of them faced cultural issues. In 2019, M. Khanum with research fellows doing their work on  LHW faced problems related to the deficiency of medicine and unequal pay. Systematic random sampling is used. This study discussed data analysis and made categories of socio-demographic respondents. In 2014, W. Odendaal, and S. Lewin worked on Community workers playing a role as lay workers. They don't have training. They provide treatment for HIV/AIDS. Data is collected and then categories of patient's waiting time and contact time. Home assessment is used to describe risk and treatment. In 2022, F. Ahmed with his team studied about CMAM Therapeutic program in Southern Punjab. They give treatment in the Rajanpur district. Exploratory study and interview method used for this study. The priorities of health care on a micro level. This study focused on health staff. In 2021, Salah ud din, Jabeen, and Meer did their work on Community health workers providing health services in low income. Their job is very tough. In Pakistan, LHW provides services in remote areas. Quantitative research method and cross sectional survey method used. They discuss the problems and professional duties. LHW can not give proper time to their families. In 2019, Shahmalak and his team members discussed Depression as the most common problem among people. LHW creates awareness and gives treatment. They used an Electronic database and thematic analysis method.  LHW was satisfied with their work but along with that, they wanted more supervision. In 2017, Bahar with team members worked  In many areas of KPK where LHW faced threats. They faced difficulty during their work. They used methods of In-depth interviews, and focus group discussion. LHW faced problems during the Polio vaccination. They have security problems. In 2015, G. Yasin and M. Shahzad worked with community midwives and lady health workers in Rural Punjab. They used the qualitative exploratory method and in-depth interviews of 30 participants. Their study shows that women are insecure about CMWs. Women thought they mishandled their delivery cases. Even they are unaware of the presence of CMWs and LHWs. 

Methodology

Pakistan is one of the big cities with greater number of population. They have many hospitals. They also have many health care units for people where they try to provide basic health services. In 1994, they started the program of Lady health workers for domestic health care services. This program is for all the people in urban, rural, and slum areas of Pakistan. These workers faced many issues. Sometimes people feel hesitant to discuss their problems. Some people also make bad comments about workers. 

This study uses explanatory methodology to collect and analyze the data. This study uses a purposive sampling technique because it requires data specifically from LHWs. The unit of analysis is LHW. This study is held in Kallar Syedan. The locale is basically the rural areas of Kallar Syedan city. Lady health workers are important respondents who provide domestic health care services to people. In this study, we use systematic random sampling from the list that is given about lady health workers. It is not possible to collect data from the entire population. We conduct interviews with female health workers. An interview is a tool. Respondents are sometimes not very qualified or well-educated. The basic purpose is to understand the problems that are faced by female health workers related to their profession, tough schedules, and domestic services. 

Results

The in-depth interview method is used. Lady health workers told about their challenges. They are the main respondents.




 

Table 1

Age	Frequency	Percentage
41-45	4	40
46-50	4	40
51-55	2	10
Total	10	100

 

Table 2

Education	Frequency	Percentage
Middle	1	10
Matric	7	70
Intermediate	1	10
Graduate	1	10

 




 

 

 

Effects of Lady Health Workers and the Reaction of People

Lady health workers have a great effect on people. People asked them about their pieces of advice and also followed their suggestions. Women don't hide anything from them. Lady health workers are trustworthy for people.

Mostly people don’t make bad comments on them because they trust them. People take them as their family.

“No, they used to do it before when this program started. In 91 When the program started, there were some pictures of a mother and child on it. If we give any medicine even paracetamol or any cough syrup they used to say that it was family planning medicine. Now they get tired of asking, but we would not have.”

“Yes very much. Now they trust us in every single thing. If any team come or even any sales man come they use to do call and ask about why they came that’s our hold in our area.”

 

Problems Faced Related to their Jobs

Lady health workers face many problems especially related to timetables. Their duty is tough. There is no sequence of their duty. They face issues because of their tough schedule. Mostly work started from 8 to 2 pm but they do their duty for 24 hours. They don't have Sunday off. They have a lot of work related to Polio, Dengue, child and mother's health. They are not paid for Dengue. Lady health workers have time and more work.

"Yes, it is. Our job has no timetable. One duty is for eight hours, from morning 8 to 2 pm but we don't have a schedule. Our duty is 24 hours In this we have to do dengue, DPI, and Work has to be done regarding mother and child Means 24 hours."

 

Reaction to Polio Vaccination and its Purpose

The purpose of Polio Vaccination is to save the life of a child from lifelong disability. Polio is a contagious disease that spreads from one child to another. If it happens, it can paralyze the child for life.

Now people are aware of Polio Vaccination. They are ready to give Polio drops to their children. People are happy with Lady health workers. They cooperate with them.

"This is the polio vaccination. Polio is actually an epidemic that can be passed from one infected child to another. It means disability of body parts A sudden stroke or something like that Which can paralyze the child for life. It is very necessary for the child."

“There are mixed impressions. People are also happy that good work is being done for our children. An awareness is reaching our homes, Our children are being saved from paralysis Some people are also refused. But Alhamdulillah, this is not the case in our field because our people are from the village, they cooperate with us."

 

Basic Health SERVICES

Basic health services are more important for rural populations than for urban populations. Cities have more facilities. They have private clinics and also have great facilities for roads and transport. Villagers mostly don't have road facilities. If they have delivery cases, it can be harmful to women. They also don't have many options for hospitals.

"It is more important for the village.  Because there is no traffic in the rural areas.  They cannot reach the hospitals quickly. And the urban population has all the facilities. Thus, the village is lacking. If there is a pregnant woman, she does not get a vehicle for delivery.  So the delivery takes place on his way. These are difficulties for her. She may also die. This is difficult for her."

 

Hesitation

People don't feel any hesitation from lady health workers. If they have any problem, they can call and ask a lady health worker. People talk to them in a friendly atmosphere. They listen to them and share their problems with lady health workers.

“No, They talk to us in a friendly atmosphere. They do not hide from us.”

 

 

Job Satisfaction

Lady health workers are very satisfied. Their salary is 32000 and they are paid 7000 extra for Polio. They have less salary for what they have done but are satisfied. They want appreciation for their jobs. They demand more salary. But they are satisfied.

“Yes! Alhamdulillah I am satisfied. But we have problems, we want to be treated in this regard. Our salary is also low in this respect. We are underpaid for polio Now our expenses in this regard are high and the salary package is low.”

Conclusion

This work is done in Tehsil Kallar Syedan. This Tehsil has 11 Union councils. It is the region of Potohar. In this area, there are many issues or challenges faced by lady health workers. These are different problems and still need solutions for their betterment. They are promoting hygiene and well being of the community especially in those regions that are developing. Lady health workers play a significant role in maintaining healthcare services and work for the betterment of maternal and child health. The findings of the data include that Lady Health workers face challenges regarding their duties and schedules. According to them, the issue of convincing should be resolved by the government. 

There are basically three findings. Firstly Lady health workers have issues related to their job sequence. The sequence in any job is really very important. They face difficulty in the timetable. Lady health workers do not have time for their families. According to them, they do not have time for special events. Secondly, they have an issue with transportation. The government does not provide any vehicles. So it is difficult to be on time. Nowadays convincing becomes a great challenge for lady them. Because most of the health workers are poor and cannot afford expenses of the transportation. Thirdly they have an issue with the Low salary package. They demand more salary. They have more work and less salary. Every work related to health in local communities especially in rural areas is done by lady health workers. But they do not get appreciation according to their task. In any community, community workers play a very important role in making the community healthy and stable. The stability of the community creates an environment that is hygienic in nature. If the environment is neat and clean, then this is the surety for healthy people and the community. So the government needs to solve their problems. They are like pillars for people. If we want to improve the health of people then we need to improve the work conditions of Lady health workers. The government should make policies which are lady workers friendly and their problems should be resolved.

References

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