Abstract
BackgroundAn estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan.MethodsA qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10.ResultsFindings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers.ConclusionThere is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision.Trial registrationClinicalTrial.gov, NCT01911494 Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0214-0) contains supplementary material, which is available to authorized users.
Highlights
An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths
This study aims to explore the potential of task-sharing to Lady Health Worker (LHW) for the community-level management of preeclampsia and eclampsia in Pakistan
There is a potential for training and task-sharing to LHWs for providing complete antenatal care; for the identification and management of pre-eclampsia in Pakistan
Summary
An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan. Around 40 million mothers give birth at home globally without any trained health worker [2, 3]. Most of the maternal, perinatal and neonatal morbidities and mortalities occur at the community level due to lack of good quality care. The poorest countries have the highest maternal and neonatal mortality rates [4, 5]. Within these countries there are dramatic inequalities, with the poorest communities and other marginalised groups experiencing considerably higher rates of maternal and neonatal mortality The majority of this burden could be averted by achieving universal coverage of good quality care and skilled birth attendance throughout pregnancy and childbirth. A more rational distribution of tasks and responsibilities among cadres of health workers is seen as a promising strategy for improving access and cost-effectiveness for MNCH interventions
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