Women health workers: improving eye care in Pakistan

(known locally as a 'lady health workers') have formed the backbone of the primary health care system for the past fifteen years. These women are members of the communities they serve and are responsible for 150–200 households (around 1,000 people) each. They provide primary health care with a focus on reproductive health and family planning. During the day, lady health workers visit women at their homes; in the evenings, community members who need help go to their local lady health worker's home (known as the 'health house') for health advice and basic care, including first aid. Using women in this role is very helpful in a country such as Pakistan, where direct interaction between women and men is not encouraged. When a woman in Pakistan wants to consult a male health worker, one of her male family members is expected to accompany her. As male family members often have to work, this can make it difficult for women to make use of eye care and other health services. Lady health workers have the advantage of being able to visit women in their homes, even when male family members are at work. Although eye care has been included in lady health workers' responsibilities since the beginning, it has not been a priority. Thanks to the renewed commitment 1 to eye care by Pakistan's national government in recent years, however, there has recently been a greater emphasis on eye care in the training of lady health workers. Lady health workers undergo three months of classroom training in primary health care, followed by field work lasting twelve months. In the classroom, lady health workers receive between three and five days' training in primary eye care. Although the time allotted to eye care has not increased, the training has recently become more in depth and a wider range of eye conditions are covered. During their year of field work, lady health workers interact with communities who have eye problems; they also receive one or two additional days' hands-on training in community eye care while in the field. The aim is for them to better understand common community eye health problems such as foreign body injuries, cataract, conjunctivitis, and trachoma. They also learn to perform vision screening and talk to community members about health and hygiene practices. Until recently, training had been provided by ophthalmologists based in district community eye care programmes. In 2007, however, …