The lady health

March 21, 2021

Lady health workers (LHWs), who’ve been serving in Pay Scale 5 for the past 28 years, with no pension, service structure or post-retirement benefits, again took to streets. Could the protests change their fate?

Post devolution, the job description for the LHWs, varies across provinces, but their core functions remain the same.

It was an unusual sight. In the wee hours of March 14, Sunday, the traffic approaching Charing Cross on The Mall had to take a major detour. As it was still dark at the time, the barriers placed in the middle of the road weren’t visible from a distance. Policemen carrying torchlights were seen directing the commuters to take an alternative route. From closer quarters, one could see scores of women sitting on the road and some lying asleep. The lights on this otherwise busy part of the road had been turned off apparently to afford them some privacy.

The women were the lady health workers (LHWs) who had staged a sit-in to press for their demands. Their protest continued for several days, disrupting movement on one of the city’s major arteries.

This wasn’t the first time the LHWs had come out in protest — there had been several occasions in the past. On some occasions they had given up after there was no favourable response from the concerned authorities. This time around, however, they received an assurance that their demands would be considered.

A lack of faith in government isn’t quite gone. Shahida, a health worker who participated in the protest, tells TNS that she has “no idea why the government can’t recognise the issues. There are those [LHWs] who’ve spent 28 years in service but have not been promoted beyond Scale 5. There’s no job structure to speak of.”

Shahida says the salary raises granted to federal government employees do not apply to the LHWs. Moreover, there is no provision of a pension or an amount that they would get upon retirement. “On paper, we have been regularised, but in reality we are terminated at will and not retired.”

Another health worker, Azra, laments that the LHWs are “expected to perform several tasks that aren’t part of their job description.” For example, she says, many LHWs are asked to cover distant areas although in theory they are only supposed to serve in their immediate neighbourhoods. They have to bear the cost of travel.

Azra also talks about the pay scale and salaries of senior LHWs which range between Rs 20,000 and Rs 21,000.

Yet another lady health worker, who does not wish to be named, says that the LHWs are being made to “perform ‘corona duties’.” This entails visiting high-risk areas unguarded.

“We risk our lives for the safety of the people… It hurts when the government disowns us. We feel like we’re being treated as disposables.”

Some of the protestors have had to pay the price for speaking out. Rukhsana Anwar, a campaigner for the LHWs, says that she and a few other leaders of the movement were removed from service because for raising their voice for their rights. “It’s strange that the Punjab health minister, who has herself been the leader of a doctors’ association, took things personally and refuses to reinstate us,” she says.

For the uninitiated, the LHWs were part of a donor-funded national programme. In 2008, following their protests, their services were regularised and placed under the control of the provincial governments. After the devolution of health services to the provinces under the 18th Amendment, it was feared that no one would take ownership of the programme.

The LHWs are “expected to perform several tasks that aren’t part of their job description.” For example, they are asked to cover distant areas even though they are supposed to serve in their immediate neighbourhoods only and they have to bear the cost of travel. — Photos by Rahat Dar

As per an LHW Programme (LHWP) document, the goal of the initiative was to ensure “the provision of primary, preventive, promotive and curative care services mainly in marginalised, remote, rural and urban slum communities, with the main objective of providing these services at the community level, particularly for women and children.”

Post devolution, the job description for the LHWs varies across provinces, but their core functions remain the same. These include acting as a liaison between the community and the formal healthcare system, promoting family planning, dissemination of educational messages related to health, nutrition and sanitation; promoting and undertaking children’s immunisation; offering preventives and treatment of common ailments; undertaking nutritional interventions such as growth monitoring and anaemia control; provision of antenatal, natal and postnatal care; referring patients to nearby health facilities and community midwives (CMWs); and engaging in other post-devolution programmes, particularly, to do with polio.

Syed Hammad Raza, deputy director information and PRO to the minister for health, says that some of the issues pointed out by the LHWs have already been resolved. He says the rest should be taken care of as per government policy.

He denies that the health minister has overlooked the protests. “In fact, she’s made it clear that the government is ready to talk to the protestors but they must clear the roads.”

About Rukhsana Anwar’s removal from service, Raza says: “She was sacked on charges of misconduct and misbehaviour with her seniors.” He says the faction of the LHWs she is heading isn’t the one the government has been talking to.

“The protest was called off once [the LHWs] understood that the government was seriously considering their demands that include introduction of a cadre for the LHWs, promotion to higher pay scales, salary raises, reimbursement of fuel expenses, provision of pension and retirement benefits.”

Raza says that an eight-member committee, composed of four members each from amongst the protesting LHWs and the government, shall take things forward from the current point. “There are around 50,000 lady health workers in the Punjab. Meeting their demands has a financial cost for which proper deliberations are needed. The government is working towards it.”


The writer is a   staff member and can be reached at [email protected]

The lady health