Work-Related Stress in Community Health Workers

High rates of child mortality and mother mortality have been reported in Pakistan. Lady Health Workers (LHWs) have been entrusted as agents for the delivery of mother and child health care at grass root level, under the auspicious of National Family Planning & Primary Health Programme since 1994. The programme has been evaluated externally and its variable success has been reported along with recommendations for improvement in quality services delivery. However, LHWs’ work-related stress and perception of their job description and problems have not been scientifically researched. Research in other countries has suggested that workers’ level of stress, nature of perceived job description and problems directly affect their quality of work.

Save the Children (SC/US) and HDRF conducted a multi-method study to assess the level of job related stress. All LHWs from one typical rural sub-district in Rawalpindi were surveyed. Focus group discussions with a sub-sample of LHWs were carried out to identify their job related problems and suggest how to improve their job description and local practices for the care of newborns. LHWs identified an in-depth list of their problems, suggestions and local practices for the care of newborns.

The study showed that about a quarter of the LHWs had significant occupational stress. Factors associated with stress included having low socio-economic status and traveling long distances for work. Inconsistent medical supplies, inadequate stipends, lack of career structure and not being equipped to communicate effectively with the families were the main factors for job dissatisfaction among these workers. LHWs perceived that job description significantly differed from the actual one. This situation is adversely affecting their efficiency to deliver mother and child health care services as ‘key primary service delivery agent’.

Recognizing LHWs’ work-related stress and problems, it was cognized that effective joint measures should be initiated to improve the quality of their crucial role at primary health care level. In addition, communication skills learning should be made an essential part of their training programme.