Impact Data - Lady Health Worker Programme
Initiated under the Ministry of Health, the Lady Health Worker Programme (LHWP) aimed at integrating family planning (FP) into the doorstep provision of primary health care. Lady Health Workers (LHWs), who have a minimum of 8 years of education and are residents of the community they serve, undergo 15 months of training. They then serve approximately 1000 individuals, delivering a range of services door-to-door related to maternal and child health, including immunisation promotion, growth monitoring, FP, and health education. They treat minor ailments and injuries, and are trained to identify and refer more serious cases. Their FP responsibilities include motivating women to practice FP, providing pills and condoms, and referring for injections, intrauterine device (IUD) insertion and care, and sterilisation.
Methodologies
Evaluators carried out a random sample survey of 4277 women living in households served by the LHWP and those living in control areas. In the served population, interviews were conducted with LHWs, the households they serve, groups of men and women in the communities where they work, the LHWs' supervisors, and key staff at the government health facilities to which the LHWs are attached. In control areas, information was collected from households, health facilities, and the community.
"The lack of an experimental design limits the confidence with which programme effect can be inferred. Nevertheless, two different analytical approaches are employed that together provide a relatively strong test of programme impact. First, trends in ever-use of modern reversible contraception over time are compared between programme and control area, based on retrospective information provided by respondents. Secondly, two-level statistical modelling was performed using the software package STATA to estimate the effect of the LHWP on the current use of reversible modern methods in rural areas, controlling for other differences between the two populations. Logistic regression with a random effect was applied and results are shown as adjusted odds ratios with 95% confidence intervals and p-values for the significance of the difference between these odds ratios and one. Women with no children were omitted from the logistic regression analysis because they were not asked whether they wanted any children, reducing the sample from 4277 to 3759 women."
"The lack of an experimental design limits the confidence with which programme effect can be inferred. Nevertheless, two different analytical approaches are employed that together provide a relatively strong test of programme impact. First, trends in ever-use of modern reversible contraception over time are compared between programme and control area, based on retrospective information provided by respondents. Secondly, two-level statistical modelling was performed using the software package STATA to estimate the effect of the LHWP on the current use of reversible modern methods in rural areas, controlling for other differences between the two populations. Logistic regression with a random effect was applied and results are shown as adjusted odds ratios with 95% confidence intervals and p-values for the significance of the difference between these odds ratios and one. Women with no children were omitted from the logistic regression analysis because they were not asked whether they wanted any children, reducing the sample from 4277 to 3759 women."
Practices
While past efforts to promote family planning in Pakistan have been disappointing, contraceptive use has more than doubled since the LHWP's inception, rising from 11.9% in 1990-91 (National Institute of Statistics and IRD/Macro International 1992) to 27.6% in 2000-01. Women served by LHWs are significantly more likely to use a modern reversible method than women in communities not served by the LHWP:
- In 1993, the proportion of currently married women who had ever used a modern reversible method of contraception was similar in both the LHW and control populations. Between 1993 and 2000 the proportion of ever-users increased in both populations, reflecting a secular trend during the 1990s. However, by 2000 ever-use of modern reversible methods was substantially higher in LHWP areas compared with control areas. The increase in the use of modern reversible contraceptives in the served rural population also appears somewhat larger than in the national rural population as a whole, where it increased from 14% in 1994-95 to 32% in 2001-02.
- Trends within the cohort of women who were married and aged 15-40 in 1993 indicate a greater increase in ever-use of modern methods in the served population (from 9.3% to 40.3%) than in the control (from 8.7% to 27.5%).
- "These data suggest that the higher level of contraceptive use seen in rural LHW areas has occurred after the introduction of the LHWs, and is consistent with the hypothesis that LHWs have played a role in increasing contraceptive use in the population that they serve. However...LHW areas are more advantaged than control areas on a number of socio-economic indicators, and this may impact on the uptake of modern reversible methods in these areas. Logistic regression is used to control for these factors....The net effect of the LHWP on the use of reversible modern methods is substantial and significant (OR = 1.50, 95% CI = 1.04-2.16, p = 0.031)."
Source
Email from Megan Douthwaite to The Communication Initiative on March 11 2005; "Increasing Contraceptive Use in Rural Pakistan: An Evaluation of the Lady Health Worker Programme" [PDF], by Megan Douthwaite and Patrick Ward, Health Policy and Planning 20(2):117-123, 2005.
Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.
Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.
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