Recognising the unsung

It looked like a battlefield, as the police fired tear gas shells at the protesting government employees who were demanding a raise in basic salary in Islamabad’s D Chowk on Feb 10, 2021. Toxic gas blanketed the streets. Angry protesters ran helter-skelter.

Four days later, Interior Minister Sheikh Rasheed Ahmed tried to bring humour to this horror. He joked that it was “necessary to test the tear gas as it had not been used for a long time”. Clearly his comment is crass, insensitive and utterly misplaced – for amidst this chaos, tragically, sepoy Ishtiaq died of inhaling the poisonous gas.

Just think: a group of federal and provincial government employees, organized under the umbrella of the All Government Employees Grand Alliance, charged by an unenviable feeling of anger and injustice in their employment, are mishandled by security personnel, and the minister chooses to defuse the situation by making a bad joke – than protecting people’s right to freedom of peaceful assembly and heeding the demands of government employees.

Among the protesters were also some 1,500 lady health workers, pressing for their unmet demands to rationalize their service structure, pension and gratuity.

An agreement was reached between the protesters and the government, whereby among other points it was agreed that “disparity reduction allowance at 25 percent of basic salary” would be granted to federal government servants in BPS 1-19, who have not been allowed “additional salary equal to or more that 100 percent of the basic salary”.

But the government withdrew 17 departments from the agreement’s ambit, including the health department – which entails that the gains of LHWs from this latest demonstration on the streets have been nil.

LHWs have resorted to street power regularly. The one before Feb 10 this year was in October 2020, when, after a series of negotiations, State Minister for Parliamentary Affairs Ali Muhammad Khan had promised to address their concerns. But the agreement was shelved and forgotten in no time.

Bushra Arain, one of the founding members of the All Pakistan Lady Health Workers Association, says “the governments hear us only after we show some muscle”. Hence street protests have become their regular medium to communicate with the governments, rather than sit at the dialogue table and discuss demands. In fact, their communications with governments follow a cyclical pattern – street protest, agreement, disregard for agreement, court cases, street protest, agreement…

More than 150,000 lady health workers reach out to 60-70 percent of the country’s population residing in rural and low-income urban areas. They are expected to visit five to seven houses every day, advising their clients (mostly women) on promotive, preventive, curative and rehabilitative services, including family planning services, antenatal referrals and immunisation services, nutrition – and these days also Covid-19 care and protection. Each one is responsible for 1,000 people, or 150 homes.

Going door-to-door, they know some of the most intimate details about their clients. By counseling women on reproductive rights and health to women, they are able to indirectly reach out to men as well. According to the Oxford Policy Management that reviewed the Lady Healthcare Workers Programme in Pakistan, the population served by LHWs has substantially better health indicators than that which is not.

However, to upgrade the reproductive and other basic healthcare needs of client families in rural and low-income areas, LHWs have endured significant hardships, like low and delayed salaries, shoddy service structure, corruption and gender violence. By 2008 lady healthcare workers learnt that to bargain for their rights, they needed to adopt a collective approach. The leaders among their cadre initiated a mass mobilization campaign to form a union – the All Pakistan Lady Health Workers Association – in 2010. Soon after, they realized that to strengthen their collective bargaining power they needed legal coverage as well. Lady health supervisor Bushra Arain, along with Rukhsana Anwar and Saima Rafiq, registered a complaint with the Human Rights Cell of the Supreme Court in 2009, followed by another application in 2010. The SC directed the federal and provincial health ministries to raise the wages of LHWs, supervisors, account officers and drivers to the national minimum wage of Rs7000 per month under the Minimum Wages for Unskilled Workers Ordinance 1961.

Arain and her colleagues pushed the governments for implementation of the court order for the next two years. Giving up, they filed a case against the state authorities for committing contempt of court. And ever since they haven’t given up the fight for their rights. Once the minimum wage was set, the next task before them was to get their service regularized.

They have fought tirelessly to get promises from the state authorities and to see them take shape – through almost 12 years of street power and strikes and six court cases. According to a PILER report by Zeenat Hisam, titled ‘Valuing women’s care work in Pakistan: Lady Health Workers’ Struggle for Rights and Entitlements’, “The union took to legal intervention and street power to claim their due rights at work place. The phenomenon was unique: never before in Pakistan’s history had women workers exercised the right to ‘collective bargaining’ in any sector, much less in the low paid care economy.”

The injustices subjected to lady health workers drew the attention of the PTI. The party manifesto vows to “double the size of the LHW programme”, which it says will “ensure each woman has access to [a] complete package of Lady Health Worker (LHW) services”.

After almost three years in government, perhaps it’s time for the PTI to highlight the ignored truths: limiting LHWs will only mean weak health conditions in far-off and deprived areas of the country. Those who lead and govern simply cannot ignore them. The Lady Healthcare Workers Programme is vital to the country. It is time to get serious and not seek humour in your own peoples’ sufferings.

The writer is a freelance journalist based in Lahore.