Pakistan’s Lady Health Workers – empowerment + healthcare

August 1, 2013

     By Duncan Green     

Just finished the paper for the UN on where/how governments have managed to empower poor and excluded groups and individuals. Thanks to everyone who suggested links when I blogged the outline back in June. I’ll do a summary when it’s out, but thought I’d share a few of the dozens of case studies dug up by my brilliant research assistant Sophie King (if you’re looking for a top notch politics of development RA, get in touch). First up, a Ros Eyben study on Pakistan’s ‘lady health workers’.

The Lady Health Workers programme (LHWP) provides reproductive healthcare to women by employing almost 100,000 women as community health workers. They provide information, basic services and access to further care. Women are now more visible and mobile within the communities where the LHWs operate. The LHWs receive training, are knowledgeable, earn their own income, and gain respect, challenging gender imbalances in the home and the community.

Empowerment outcomes:

  • Taking a paid job increases the LHWs’ education through training and work experience, which results in increased decision-making power withinlady health workers the family and mobility in the community, breaking down caste, class and gender barriers.
  • Some LHWs have become leaders in their communities because of the relationships they have had to forge across class and caste barriers There have been shifts within the practice of Purdah in response to negotiations about the LHWs travelling around unaccompanied
  • Their work has spurred collective action such as resignations among a group of LHWs in one town in reaction to defamatory reports in the local press, and collective protests by LHWs against sexual harassment, including their refusal to participate in an immunisation campaign until a case had been brought against the perpetrator. (See pic and caption for another example)
  • The women in receipt of the health service itself benefit, particularly as women of child-bearing age are those most restricted from public exposure

Drivers of success:

  • The initiative builds on existing processes of socio-economic change taking place in Pakistan including rapid urbanization, increased exposure to media, increasing acceptance of female education, many women wanting to work especially following access to education
  • The initiative is driven by the state, which earns the women the respect of having a ‘government job’.
  • Government-run television adverts helped women to gain credibility


  • Lowest castes have been marginalised by some LHWs in terms of the service and employment opportunities as LHWs, partly because it requires at least the completion of primary education.
  • Other women or girls in the family often have to make sacrifices to free up the time for LHWs to perform their duties
  • Programme not as effective in peri-urban areas because they do not have the same level of community cohesion, there is a mix of ethnic groups, LHWs don’t have same ethnic and kinship ties; and because of this, families are more disapproving.

More background: an evaluation in the Journal of the Pakistan Medical Association; LHWs take on child pneumonia and a commentary in the European Journal of Public Health. Any more recent updates welcome.