The Punjab Paramedical Staff, which has now been renamed as the Pakistan Allied Health Professionals Organisation (PAHPO), and Lady Health Workers (LHWs) association have announced to launch a series of rallies and sit-ins in Lahore during the months of February and March against the PTI-led government. The reason behind this threat is the government’s unsatisfying response to the demands of health workers and a recent cut in the bonus of emergency staff of all public hospitals.

Legislation for professional allowance, risk allowance and restructuring of all staff from grade 1 to grade 16, outstanding dues, increase in salary, the establishment of Allied Health Professional Regulatory Authority, pension for lady health workers, and the recruitment of new staff are among the demands of both PAHPO and LHWs.

There are two independent tiers of professionals who support the core medical staff in their healthcare services; paramedics and allied health professionals.

The province has 78,686 registered paramedics and 14,120 sanctioned seats in public sector health facilities, and 8000 registered allied health professionals and 6192 seats in public sector health facilities. According to the international benchmark of 2.7 per 1000 population, Punjab requires at least 289,000 allied health professionals to cater to the needs of its population.

Certainly, a major challenge faced by Punjab’s health sector is the imbalance in the health workforce characterised by a lack of sufficient health managers, nurses, paramedics and skilled birth attendants.

"Most of the paramedics or health professionals including laboratory technicians, operation theatre technicians, dispensers and other staff are serving on a contractual basis or daily wages for the past five to 20 years. Moreover, their wages have not been increased according to dearness and inflation during that period," spokesperson PAHPO Shoaib Anwar Chaudhry said.

The doctors can no doubt accomplish little in terms of proper healthcare delivery without paramedics, nurses, midwives and allied staff. Nevertheless, their pay scale is ridiculously low compared to the work load. "A staff member of grade 6 takes home around Rs18-19,000 per month. Our demand is to increase the pay scale and make it equivalent to the federal employees in each grade.

"Fifty percent bonus being given to the emergency staff in all hospitals since Chaudhry Pervez Elahi’s government (2002-07) has been taken back by the PTI government. This step has created great panic amongst already frustrated paramedics," said Chaudhry.

President LHWs Association Rukhsana Anwar shows disappointment on the policies current government is taking in the health sector. "The Punjab government has shown little seriousness to address the grievances of more than 50,000 lady health workers serving in the province. We have little hope from the government that is not ready to even sit with us.

"Despite the fact there are no allowances available to us, the hard work the lady health workers have done in the eradication of dengue and polio cannot be ignored. In addition, the pay scale is trivial in comparison with the work load; lady health workers retire without any pension; and government is holding strict stance on recruiting. The service structure of Lady Health Supervisors (LHSs) and Lady Health Workers (LHWs) along with the up-gradation of our basic pay scales are urgent demands," said Anwar.

Both LHWs and PAHPO have threatened to take their agitation from the provincial capital to other districts as well if their demands are not considered.

Hammad Raza, spokesperson Punjab Health Department, claimed that the number of protests of health workers that used to be more than 200 in year are reduced to a few in the last six months which shows the satisfactory steps being taken by the ministry of health in the province. "The minister for primary and secondary healthcare Dr Yasmin Rashid strictly avoids giving any wrong hopes to anyone, which is why most of the workers of health department are satisfied and prefer giving time to the new government".

He assures that a great package for paramedics and lady health workers is under process. "The government does believe that 30,000 nurses in the whole province are unable to cater to patients; that is why a decision has been made to recruit more. Moreover, male nurses, for the first time, would be recruited to cater to male patients -- the recruitment process will commence soon."

The minister Dr Yasmin Rashid has constituted a committee under secretary health to prepare recommendations for the service structure, pay scale and pension issue of paramedics, allied health professionals and lady health workers. This specific committee does have the mandate to revisit the decision of taking fifty percent monthly bonus back. However, the minister will take the final decision based on the recommendations.

Certainly, healthcare plays a vital role in sustaining human capital hence the healthcare delivery system in a country must be robust. Punjab still faces a high burden of disease and key health indicators show a poor performance. This is indicative of shortcomings in the service delivery mechanisms, lack of heath professionals and inefficient resource allocation. These weaknesses need to be addressed in order to counter the problems that have led to an underutilised primary level and an over-burdened tertiary level of healthcare services.

Historically speaking

Pakistan’s international commitments that led to the 1994 Lady Health Worker cadre

As a signatory to the Alma-Ata Declaration of 1978, the Government of Pakistan is committed to ‘health for all’ through the primary care approach. In 1994, the government launched the Prime Minister’s Programme for Family Planning and Primary Health Care through the Ministry of Health, with the aim of preventing and treating common ailments at the community level in a cost effective manner.

The main priorities identified include controlling communicable diseases, promoting health awareness and prevention, strengthening primary health care (especially in rural areas), developing an equitable health system and good governance, including improving district professional and managerial deficiencies.

Through the programme for Family Planning and Primary Care, the government created the Lady Health Worker cadre in 1994.

-- S. Warraich