Understanding the role of lady health workers in improving access to eye health services in Khyber Pakhtunkhwa (KPK) Province of Pakistan

Main objectives

In 1994, the Lady Health Workers (LHWs) programme was established in Pakistan to increase access to essential primary care services and support health systems at the household and community levels. LHWs are salaried, fully recognised members of the public sector health workforce. In Khyber Pakhtunkhwa (KPK) province in northern Pakistan, eye care is among the many unmet needs that LHWs were trained to address, including screening and referral of people with eye conditions to health facilities. However, compliance with referrals, especially among women in KPK, has been very low. We explored the role of LHWs in patient referral and the barriers to patient compliance with referrals.


Between April and June 2019, we conducted a qualitative study in KPK. We captured a range of experiences and opinions from a diverse group of 73 participants that included patients, LHWs and their supervisors, district managers and other stakeholders across two different sites through eight focus group discussions and nine in-depth interviews.

Results from this study have shown that the training of community health workers in eye care was well received. However, training alone is not enough and does not result in improved access for patients to specialist services if other parts of the health system are not strengthened. The role of LHWs in eye care in a given programmatic context should be articulated and their responsibilities and competencies should be clearly defined. Pathways for referrals should be agreed and explicitly communicated to both the health care providers and the patients. Attention should be paid to how LHWs are remunerated and supported to prevent their overburden and demotivation. The role of LHWs could be made particularly effective and should be strengthened in providing patients with accurate information about eye diseases and services available and in delivering alternative more gender-focused services tailored specifically to the needs of women.


Study details
Start date
Finish date
Main contact
Stevens Bechange
Senior Research Adviser
  • Sightsavers
  • Fred Hollows Foundation
  • Pakistan Institute of Community Opthalmology (PICO)