Analyzing the Impact of Lady Health Worker Program on Utilization of Maternal Health Services in Community With A Lady Health Worker in Sindh Province

The study aims to analyze impact of Lady Health Worker program on use of maternal health services in community with a lady health worker. The main focus was the rural districts of Sindh for this case study. The maternal health service is determined by at least four Antenatal care (ANC) visits provided to mother and receipt of at least two Tetanus Toxoid (TT) injections to mother during pregnancy. These have direct impact on maternal mortality rate and infant mortality rate. Secondary data pertaining to all districts of Sind for three years (2017-2019) was collected from the Sindh Lady Health Worker program office Hyderabad for analysis purpose. Further secondary data of Pakistan Demographic and Health Survey (2017-18) was also used to see the impact of intervention of LHW program implemented by Ministry of Health Pakistan in 1994 and then devolved to provinces after the implementation of 18th Constitutional Amendment in 2010. The study found that the services provided by the lady health workers in communities in these districts has positively influenced the uptake of maternal health services as determined by the variables like antenatal visits by pregnant mothers to nearest health facilities and receipt of Tetanus Toxoid injection during pregnancy.

Stepping Up Lady Health Worker (LHW) Program and Integrating the Electronic Immunization Record and Tracking System into the Program as a Pilot Project in the Underserved District of Quetta, Balochistan, Pakistan

Pakistan is one of those countries which are continuously struggling with providing essential primary healthcare services, especially in rural and underserved areas. To combat vaccine-preventable diseases, the Expanded Program on Immunization (EPI) has been active since 1978. Additionally, Lady Health Worker Program (LHWP) fits best with district health priorities of mother and child healthcare, family planning and National Immunization Days (NIDs). However, Pakistan faces many challenges. One is significant disparities in allocation and retention of LHW between provinces such as Punjab and Balochistan. Others are the lack of formal training and management of LHWs and a lack of immunization record system leading to vaccine wastage and broken logistics. How other low to middle-income countries (LMIC) are addressing these issues, is evident from Bangladesh and India. The Shasthya Shebika (SS) Program of Bangladesh is unique in having strategies for focused, structured training and retention of community health workers (CHWs) who receive small loans to establish funds, which they use to sell medical products to the community. To tackle the issue of lack of immunization data and vaccination wastage due to inadequate inventory, India has launched an Electronic Vaccination Intelligence Network (eVIN). The Ministry of Health, Pakistan has the potential to start a healthcare project to address the challenges mentioned above. The recommendations include allocation of 500 LHW (lady health workers) in the underserved district of Quetta in Balochistan with the implementation of retention strategies by funding LHW for small businesses, providing a formal educational structure and training and supervision of LHWs for innovative electronic immunization system. LHWs will have access to relevant educational materials and electronic devices such as tablets.

Intensive monitoring and interpersonal counselling by lady health worker improves the coverage of vitamin A among children between ages 6 and 59 months in selected low performing provinces of Pakistan

Background: Nutrition International, previously known as Micronutrient Initiative, has been supporting the government of Pakistan to address vitamin A deficiency in 24 districts of Balochistan and Khyber Pakhtunkhwa and 78 union councils of Lahore and Karachi. The program aims to improve capacity of health managers and frontline workers on supply chain management and monitoring; monitoring of stock-outs at health facilities and frontline distribution points; and focus on regular monitoring and supervision through EPI and health departments. Challenge however remains in achieving meaningful coverage. The Nutrition International piloted an intensive monitoring strategy in a sub-set of four districts of Balochistan and KPK and 14 union councils in Karachi and Lahore with an aim to improve coverage of vitamin A. The study assessed the changes in coverage of vitamin A supplementation 2011 to 2012 due to the intensive monitoring.Methods: Two rounds of repeated cross-sectional mixed-methods surveys were conducted on a sample of 2,579 and 2,580 caregivers during baseline and end-line respectively. Low performing districts identified in each of the four provinces constituted the study domain. The sample of households in each region was selected using a two stage cluster sampling strategy.Results: The coverage of Vitamin A registered an absolute increase of 35.7 percent points in the intensive monitoring districts compared to the other districts, where it was 29.6 percent points in the end-line over the baseline.Conclusions: It was observed that intensive monitoring and interpersonal counselling by lady health worker is instrumental in improving the coverage of Vitamin A in certain programmatic settings in Pakistan.

Evaluation of the uptake and impact of neonatal vitamin A supplementation delivered through the Lady Health Worker programme on neonatal and infant morbidity and mortality in rural Pakistan: an effectiveness trial

BackgroundDespite evidence for the benefits of vitamin A supplementation (VAS) among children 6 to 59 months of age, the feasibility of introduction and potential benefit of VAS in the neonatal period in public health programmes is uncertain.ObjectiveThe primary objective was to evaluate the feasibility and effectiveness of early neonatal VAS (single dose of 50 000 international units within 48–72 hours after birth) delivered through the public sector Lady Health Worker (LHW) programme in rural Pakistan and to document its association with a reduction in mortality at 6 months of age.MethodsA community-based, cluster randomised, placebo-controlled trial was undertaken in two districts of rural Pakistan. LHWs dispensed vitamin A/placebo in identical capsules to newborn infants within 48–72 hours of birth. Follow-up visits were undertaken at 1 week of age and every 4 weeks thereafter until 6 months of age.ResultsOf a total of 15 433 consecutive pregnancies among eligible women of reproductive age, 13 225 pregnancies were registered, 12 218 live births identified and 11 028 newborn infants reached by LHWs. Of these, 5380 (49%) received neonatal VAS and 5648 (51%) placebo. The LHWs successfully delivered the capsules to 79% of newborns within 72 hours of birth with no significant adverse effects. Although the proportion of days observed with symptoms of fever, diarrhoea or rapid breathing were lower with neonatal VAS, these differences were not statistically significant. Mortality rates in the two groups were comparable at 6 months of age.ConclusionsWhile our study demonstrated that neonatal VAS was safe and could be feasibly delivered by LHWs in Pakistan as part of their early postnatal visits, the overall lack of benefit on neonatal and 6-month morbidity and mortality in our population suggests the need for further evaluation of this intervention in populations at risk.Trial registration numberClinicalTrials.gov NCT00674089.

Treatment Supporters and Their Impact on Treatment Outcomes In Routine Tuberculosis Program Conditions In District Rawalpindi, Pakistan

Background: Tuberculosis (TB) is a major cause of mortality and is affecting millions of people in third world countries. In DOTS patients are monitored facility based and treatment supporter based; by these two ways patients are observed for the treatment. The aim of the study was to explore the role of treatment supporters and their impact on the treatment outcomes. Material and Method: The study was a cross-sectional survey within routine TB control program operational context. All sputum smear positive TB patients diagnosed, registered in public sector, urban and rural diagnostic centre during year 2008 with available outcomes were included in the study. Data was collected during August- October 2010 from 15 health facilities of 451 patients. Results: The majority of the patients (89.6%) were provided with treatment supporters. In 404 (89.6%) cases in which treatment supporters were provided, 203 (50.2%) were lady health worker, 46 (11.4%) were community health worker and health facility worker, and 155 (38.4%) were family member and community volunteer. 384 (85.1%) were categorized as “treatment success”, 31 (6.9%), as “transferred out”, 17 (3.8%), as “dead”, 16 (3.5%) as “defaulted” and three (0.7%) as “treatment failure”. The treatment success rates in patients supervised by lady health worker, community health worker and health facility worker, and family member and community volunteer was 93.1%, 89.1% and 73.5%, respectively. Conclusions: We found a significantly higher treatment success (93.1%) in patients supervised by lady health workers compared to other types of treatment support. The overall treatment success rate was 85.1%.DOI: http://dx.doi.org/10.3329/jom.v14i1.14535 J MEDICINE 2013; 14 : 40-46