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Can Nurse. 1997 May;93(5):32-4.

Pakistan's community health workers.

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McMaster University Faculty of Health Sciences, Hamilton, Ontario.


Pakistan's health characteristics are worse than those of other Asian countries at similar stages of development. Its mortality rate for children under five is 139 per 1,000, and its maternal mortality is 60 per 10,000. Malnutrition in women and children is widespread; 50 per cent of children under five are stunted. Pakistan's population growth rate of 3.1 per cent per year is among the highest in Asia. The high population growth rate and poor health status of many people call for extensive health care services, but, unfortunately, health services do not reach most of the people of Pakistan. Partly because the training of doctors and nurses is lengthy and expensive, there is an acute shortage of health care providers, especially women. Although female health professionals are preferred for caring for women, cultural constraints inhibit women from seeking education. Such is the multifaceted dilemma in the provision of primary health care in Pakistan.


In Pakistan, the mortality rate for children under age 5 is 139/1000 live births, and the maternal mortality rate is 60/10,000. 50% of the children under 5 are stunted as a result of malnutrition. There is an acute shortage of health care providers; therefore, the Medical College and School of Nursing at Aga Khan University, Karachi, developed a community health service model that proposes a primary health care field team composed of community health nurses and doctors, lady health visitors, and community health workers (CHWs). Most community health nurses are graduates of a 3-year nursing program at the Aga Khan University School of Nursing followed by 1 year of midwifery training. In addition, graduates of the newly established BScN program are entering the system as community health nurses. Community health doctors are medical graduates whose education has emphasized clinical and theoretical knowledge of primary health care. Lady health visitors are the mid-level health care providers who deliver health care to mothers and children under age 5. They are high school graduates whose 2-year training includes midwifery, covering prenatal care, delivery care, postnatal care, and newborn care. CHWs have attended the CHW Training Program at Aga Khan University in order to provide preventive and promotive maternal and child care in their communities. The role of the CHW is to be an essential and permanent member of the health care system. The CHW encourages collection, storage, and use of clean water and garbage disposal; offers information about prenatal and postnatal care; refers women with pregnancy complications; encourages breast feeding; demonstrates food preparation for infants and toddlers; explains the management of diarrhea and vomiting; instructs about adequate prenatal nutrition; encourages immunization of pregnant women and children; and monitors the growth of children under age 5.

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