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PAKISTAN: Health Workers Without Maternity Leave

Zofeen Ebrahim

KARACHI, Apr 27 2011 (IPS) - Shazia Kiran is seven months pregnant with her third child and worried she might be unable to juggle her work and the responsibilities of caring for a newborn. But what worries her more is that she has no maternity benefits, and she has not received her salary as a Lady Health Worker (LHW) for the last three months.

“We don’t get maternity leave and the most my supervisor will allow will be ten days, after which I will have to get back to work,” Kiran told IPS.

“The way food and fuel prices have skyrocketed, it is becoming increasingly difficult to run the house on just one person’s salary,” she added, wondering how her family of five will subsist on the salary of her husband, a clerk in a government office.

For the past 16 years, Kiran has worked as an LHW in her neighbourhood in Korangi, one of Karachi’s 18 administrative units. She goes door-to-door talking to women about their well-being, how to take care of themselves during and after pregnancy, birth spacing and the use of contraceptives, immunisation against childhood diseases – spreading health and hygiene messages.

Kiran helped make the LHW programme one of Pakistan’s big success stories, the largest community- based initiative, running for nearly two decades now.

But this huge success has failed to care for its own people, the LHWs say, keeping its 130,000-strong workforce contractual employees without medical and other benefits, and even neglecting to pay them for the last three months.

LHW district and provincial coordinators have told the workers that the government has not released the funds for the programme in time for them to pay salaries.

“We take our work seriously, then why are we not taken seriously?” asked Bushra Arain, president of the All Pakistan Lady Health Workers Employees Association.

“Whatever success Pakistan has achieved towards bringing down infant and maternal mortality rates, or in meeting the targets for the Millennium Development Goals 4 and 5 (reducing child mortality and improving maternal health), would not have been possible had the LHWs not been going door to door,” she said.

Last month, over 2,500 LHWs and their supporters from civil society and political parties gathered on a highway between Sindh and Punjab provinces blocking all traffic, allowing only ambulances or medical cases through. The sit-in lasted for 16 hours and ended only after the police resorted to batons and tear gas to break them up. Hundreds were hauled in and locked up.

This is not the way these women feel they should be treated. In 1994, then prime minister Benazir Bhutto created a cadre of women, to be trained and deployed in the communities where they lived. Called LHWs, they were to serve as liaison between the formal health system to which they were attached, and the communities they consider home, spreading health education and sanitation messages to an average of 1,000 people each.

The official website of the National Programme for Family Planning and Primary Health Care, or LHW Programme, says it covers more than 65 percent of the target population.

The LHWs are required to have reached at least Grade 8, must be preferably married and no younger than 18 years old, and most of all, should be accepted by the community and neighbourhood.

When the LHW programme started in 1994, the LHWs were to get a monthly stipend of 1,200 rupees or 14 dollars, with an annual increment of 100 rupees or 1.17 dollars. The stipend increased to 3,000 rupees by 2010, but it wasn’t until September 2010 that Pakistan’s Chief Justice Iftikhar Muhammad Chaudhry ordered that the LHWs be paid a minimum of 7,000 rupees or 82.35 dollars, the wage a skilled worker receives.

Today, these women are demanding they be treated as regular employees. They said their workload has increased, but their remuneration has not kept pace.

“Over the years more and more responsibilities have been lugged onto us,” Kiran said. “When we started we didn’t have to work in the polio and measles campaign. If there is a patient suffering from tuberculosis in our community, we have to ensure that we go and give the drug to him or her every morning.”

During natural disasters, like the 2005 earthquake and the floods in 2010, it was the LHWs who continued providing healthcare to their communities despite being disaster victims themselves.

“If you look at our labour laws, these clearly state that (for) a programme that goes on for nine months, its employees, after they complete their three-months probation period, automatically get confirmed,” said Farhat Parveen, head of the National Organisation for Working Communities, which advocates for workers’ rights. “And this programme had been going on for 17 years!”

Others argue that LHWs are not full-time workers and enjoy flexi-hours and so cannot demand the wages and benefits of permanent employees.

But Parveen said the LHWs’ scope of work has consistently increased and they have not refused whatever they have been asked to do, in addition to what they were originally trained for.

“In many remote rural areas, where even the government-run basic health units are missing, these women are the nearest and closest you can get to in terms of emergency healthcare. They are on call all the time,” Parveen said.

Syed Taj Haider, advisor to the Sindh chief minister, has assured the LHWs that once the health sector is transferred to the four provinces, they will be regularised and will have a proper pay scale. But he pleaded for patience. Addressing a gathering of civil society organisations and LHWs, he explained that the transfer of the health sector from the central government to the provinces might take a few months.