Female health workers boost primary care

Abstract

Women residing in villages in three districts of Pakistan were recruited, trained to deliver primary care and mobilize their communities for health, assigned to limited catchment areas, provided with supervisory and managerial support, and remunerated. Their comprehensive activities substantially reduced infant, child and maternal mortality within a year and generated positive perceptions of family planning in the communities. The programme was cost-effective and appeared suitable as a model for reforming the organization and provision of health care services.

PIP: In 1993, women residing in three rural districts of Pakistan were recruited, hired, trained to deliver primary health care and to promote health-seeking behavior within their limited catchment areas (1000-1500 people), and provided with supervisory and managerial support. Each village nominated candidates for the positions who had a minimum of 8 years of formal education, lived in the villages they would serve, were aged 18-45, and were, preferably, married. Each woman underwent 3 months of initial training in the delivery of primary health care and ongoing training interposed with period of service delivery for the next year. Data collected on the village population included information about births and deaths in the previous year. The health workers kept records about births, deaths, morbidity, and service delivery. Men's and women's community groups organized to identify health priorities and strategies, and the health workers made regular home visits for health promotion, case management, and family planning services. A year after implementation, infant and maternal mortality rates dropped from 130 to 64 and from 596 to 246, respectively. There was also a highly significant drop in the mortality of children aged 1-4 years from acute diarrhea and from measles. Immunization coverage increased, contraceptive use increased, and the provision of sanitation and safe water improved. The cost of the program was US$386 per health worker. Capital and yearly recurrent costs per person of $0.39 and $1.13, respectively, were lower than public sector allocations for the same period. It is clear that trained, locally resident female health workers can improve the delivery of primary health care in Pakistan.