Community Based Services

The IRMNCH & Nutrition Program provides community based services at the door step through Lady Health Workers and Community Midwifes.

Lady Health Workers

The National Program for Family Planning and Primary Health Care, also known as the Lady Health Workers Program (LHWP), was launched in 1994 across the country. In Punjab, this initiative extends outreach health services to rural populations and urban slum communities through deployment of 44,700 Lady Health Workers (LHWs) and 1800 Lady Health Supervisors (LHSs) with 70% coverage (37% in Urban and 85% in Rural area) and contribute to bridge the gap between health facilities and communities. The current average population coverage by LHWs is 1500 in rural areas and 1800 in urban areas.

Scope of Services of LHWs

The services provided by the LHWs include registration of target groups, household visits, health education and awareness, and special campaigns. Each LHW is supervised by a Lady Health Supervisor, each supervisor having an average of 25 LHWs reporting to her.
The specific LHW target groups include:

  1. Pregnant and lactating women
  2. Children under the age of 5 years
  3. Eligible couples

The LHWs visit every registered household of their catchment population once per month and provide the following services:

  1. Pregnant women: counseling on ANC, delivery and PNC by Skilled Birth Attendants; referral of pregnant women to appropriate health facility; awareness on early identification of danger signs; birth preparedness, etc.
  2. Lactating women: advise on early initiation of breastfeeding, exclusive breastfeeding and infant & young child feeding (IYCF) practices
  3. Children: referral for immunization; linkage with vaccinator; screening of children for malnutrition; identification and referral of SAM and MAM children; basic treatment of pneumonia and diarrhea and appropriate referral
  4. Eligible couples: counseling on healthy timing and spacing of pregnancy (HTSP); provision of condoms, oral contraceptive pills and injectable contraceptives; referral for long term methods i.e. IUCDs and tubal ligation

In addition to her door to door campaigns, the LHWs also conduct health education and awareness through community support group meetings on selected topics on weekly basis. Moreover, they also participate in various special campaigns conducted from time to time by District and Provincial Governments including:

  1. Mother and child health week twice a year
  2. Global breast feeding week once a year
  3. Nutrition week in urban slums once a year

Selection criteria of LHWs and LHSs

  1. Since regularization, the Lady Health Workers have been declared a dying cadre by the Government of Punjab. Therefore, new hiring of LHWs or LHSs is not being done.
  2. The principle for hiring of LHWs and LHSs was that they would be selected from rural areas.
  3. Eligibility criteria of LHWs
    1. Female, preferably married.
    2. Permanent resident of the area, for which she is recruited.
    3. Minimum 8 years of schooling preferably matriculate.
    4. Should be between 20 to 45 years. (up to 18 years only if she is married)
    5. Preference will be given to women with past experience in community development.
    6. She should be willing to carry out the services from her home (which will be designated a ‘health house’ ensuring effective linkage between the community and the public health care delivery system.
  4. Eligibility criteria of LHSs
    1. Female
    2. Age: 22-45 years
    3. Education: (In order of preference)
      1. LHV or
      2. Graduate or LHW Intermediate with one year experience (after completion of full training) as LHW or
      3. Intermediate (in exceptional cases with prior approval of PPIU).
    4. Preferably one-year relevant experience.
    5. Local resident of the area (permanently reside in the area and registered with one of the LHWs under her supervision)

Training and Capacity building of LHWs

Induction training: The Lady Health Workers receive a robust induction training after their hiring. This includes a three months class room training followed by a nine months on the job / field training.
Refresher trainings: Each LHW undergoes multiple refresher trainings from time to time. These trainings cover recent updates and revised guidelines in each area such as nutrition (IYCF, breast feeding, CMAM, growth monitoring and screening of malnutrition), community IMNCI (diarrhea, pneumonia and other common childhood illnesses), family planning (HTSP), referral protocols, etc.
An integrated refresher training was organized for all LHWs covering all areas of her work. Each LHW has been trained on the revised refresher training manual during the year 2017.

Community Mid Wife

A special cadre of Community Midwifes was introduced in 2007 under the National MNCH Program to ensure availability of skilled birth attendants in rural areas far away from the health facilities. Young matriculate girls are recruited each year for a two years training program after which they are deployed in their own areas of residence for service provision. The training program is accredited by the Pakistan Nursing Council and the Nursing Examination Board examines each CMW before she is allowed deployment in her area.

Scope of services of CMWs

The services provided by the CMWs include:

  1. Antenatal care – complete basic package
  2. Normal vaginal delivery at midwifery home / household level
  3. Post natal care
  4. Family planning services

Each CMW is deployed over a population of 5,000 – 10,000 individuals depending on the geographical area. She provides domiciliary midwifery services in her area i.e. she provides ANC, PNC and family planning services at her midwifery home while delivery services are offered both at her midwifery home as well as at pregnant woman’s home (if she prefers to be delivered at her home). However, practically, majority of the deliveries conducted by the CMWs are at the midwifery homes.

Selection criteria of CMWs

  1. Matriculate (45% marks) with science or arts; science will be preferred
  2. Age 18-35 years, preferably married. Age relaxation may be given up to five years on special grounds subject to approval
  3. Admission is based on merit
  4. Willing to work in area from where selected for at least three years

Conditions for admission and service

  1. Post deployment mandatory service in area of deployment (bond period)
  2. Stipend of Rs. 6,000 per month will be paid for two years during the training period
  3. Monthly honorarium of Rs. 6,000 to 8,000 per month will be paid; amount is based on hardship classification of the area.

Training and capacity building of CMWs

Induction training: Each CMW is trained for a period of two years at the midwifery schools / nursing schools established in each of the 36 districts. The two years training includes class room sessions, practical and skills training at the District Head Quarter Hospitals, and also includes full time attachment with the labor rooms for hands-on training. Each CMW conducts 20 deliveries with assistance of labor room staff and five deliveries completely independently during her clinical attachment.
Refresher trainings: Deployed CMWs undergoes multiple refresher trainings from time to time. These trainings cover recent updates and revised guidelines in each area such as nutrition (IYCF, breast feeding), community IMNCI (diarrhea, pneumonia and other common childhood illnesses), Basic EmONC, family planning (HTSP), referral protocols, etc.
A special ten days refresher course has been developed for all CMWs. A continuous training program has been established to ensure that each CMW is trained at least once every two years to keep her knowledge and skills up to date.