The Nation’s Caregivers: Work Experiences, Professional Identities and Gender Politics of Pakistan’s Lady Health Workers
Lady Health Workers (LHWs) are community health workers who work under the Pakistani government’s National Programme for Family Planning and Primary Health Care, and provide basic medication, contraceptives, and nutrition and prenatal advice to expectant mothers. LHWs are a pivotal bridge between mothers, especially those who live in traditional households, and medical practitioners and policymakers. Several studies indicate that LHWs have been instrumental in decreasing maternal and infant mortality rates, lowering the incidence of tuberculosis in urban and rural populations, and treating depression among patients. In addition, they conduct vaccination campaigns including the WHO-supervised polio campaign. Since 2007 tensions have emerged between LHWs and the government regarding pay and working conditions. The LHWs have staged sit-ins, demonstrations as well as a march to the capital to highlight their plight and demand better working conditions from the government. This has resulted in disruptions in vaccination and awareness campaigns. Reports suggest that a higher morale amongst workers translates to higher productivity and more effective work results. Thus, understanding the issues affecting LHWs is essential to a more productive health care work force. By analyzing the dynamics underpinning the relationship between LHWs, the Pakistani government, and the community, policymakers can obtain a better understanding of how the intersecting influences of gender, culture and spaces impact the implementation of health care policies. This analysis could also shed light on the issue of worker retention in the medical field. Drawing from a series of semi-structured interviews conducted over a four-month period in the Pakistani city of Karachi, I analyse how LHWs view their work in relation to gender, agency, self-worth and human security in an urban setting. In addition, I locate the workers’ experiences within neocolonial and postcolonial systems. Findings indicate that while LHWs are extremely devoted to their work, a lack of security, compounded by irregular pay and gender discrimination, has contributed to low morale. The masculine and hierarchal systems LHWs operate within have contributed to the workers’ struggle to be recognised professionally. In addition, international development organisations’ agendas and government policies have had unintended and often negative consequences on LHWs’ morale and experiences.