“Lady Health Workers (LHWs) should not be asked to do security duty during elections,” said Bushra Arain, Founder and Chairperson of the All Lady Health Workers’ Programme Union (ALPU).

Acknowledging that other government workers are called in for duty, Bushra Arain pointed out that they are given easier tasks and are trained before the elections. “We are asked to do difficult duties and there is no security or training for LHWs,” she observed.

As elections are near, Bushra Arain is worried that LHWs will be again asked to work during elections without protection or training.


“LHWs are already soft targets, and elections in Pakistan are not safe, we worry for our safety,” emphasised Bushra.

Rubina Ghaffar is an LHW in Karachi, and she was called on election duty in 2018.

“Elections are near, and many of us are afraid that we will be put on security duty again,” said Rubina, “Last time we were tasked to do two things: count votes and provide security to the polling staff. We were not trained how to do this nor given any protective gear.”

Rubina continued, “On the morning of election day, a group of us were driven to the polling station early in the morning. Our duty began at 6 am and ended only when we protested and demanded that we be allowed to go home. It was very late in the night”, Rubina said. “We were brought to the polling station in police vehicles but had to go home on our own late at night.”

Rubina further said, “There was no security at the polling stations and although we were paid Rs4500 as compensation for the duty, it was not enough considering LHWs are already soft targets as we have seen. We were giving the voter list to tally with voters’ ID cards and tally the numbers.”

She added, “Afterwards we counted the votes, this was checked by the relevant people. We not allowed to leave and were asked to keep sitting despite asking to leave. We were hungry and thirsty; we had not been provided anything throughout the day although the political workers were provided with lunch and tea. We couldn’t even order food as we were not allowed to step out of the polling stations. It was only after we protested, we were allowed to go home. It was quite late, and we had to travel back in small groups.”

People living in urban areas are probably not interested in the lives and work of LHWs. They may not be disrespectful or disregard LHWs but since most of them don’t have any real interaction with them and may only meet them during a polio campaign, these women remain invisible and faceless to most of the urban population.

LHWs don’t play an important role for urban dwellers their role is quite significant for slum dwellers in many cities, as well as rural areas where a large section of the population especially women rely on the basic health services LHWs provide. Many of these people have never received proper medical service and LHWs are their link to medicines and vaccinations.

Former prime minister Benazir Bhutto launched the Lady Health Workers Programme in 1994 and at the end of the programme, LHWs were merged into the health sector. This was the logical step so that these trained community health workers could enhance health services to marginalised communities. However, instead of being beneficial for the LHWs, it only added to their problems.

“When the LHW programme ended, LHWs were absorbed by the health department. This didn’t help to improve our status. Like other employees of this department, we were government servants but unlike them, we have no benefits like promotions, pensions, or increments. The main reason for this is that we don’t have a proper service structure under which we would be given these rights and benefits,” said Bushra.

She added, “We are sent to all kinds of “special duties” including election and census duties, but we are not given any training or protection when we are doing security during elections. We worked throughout the pandemic without any protective gear or hand sanitisers. LHWs are vulnerable and we have lost many members to targeted terrorism., it is not fair to send us for election duty without proper training or protective gear.”

Bushra further said she understands LHWs will be sent on special duties like other government employees, “Why aren’t we given benefits like other members of our department? Why isn’t our service structure made despite the Supreme Court’s orders in 2012? Why are we being deprived of our rights like increments, promotions, and pensions despite the court’s order? Many LHWs have retired without receiving benefits. And when we protest, we are beaten.”

Elaborating on this, Maqsood Ahmed, trade unionist and trainer, said, “LHWs work in the most deplorable conditions. They do the work of doctors, nurses, counsellors, and community & social workers for marginalised communities. The LHWs do more than they should – this exploitation is only because their service structure has not been enforced.”

He added, “In March 2013, the Supreme Court ordered that the service structure be made for LHWs, and they be regularised. And after the 18th Amendment, the devolution of 1,56,000 LHWs including supervisors, drivers, and accountants should have been done by the provinces but this has not been done till date.”

“The Civil Servants Act governs government and public services. Different rules help to determine the number of leaves, pensions, promotions, and other benefits to the employee. Depriving LHWs of their service structure is in contravention of the Apex Court’s orders. Over time more than two to three thousand LHWs have retired increasing the workload. More LHWs should be hired as the population is increasing but this cannot be done until the service structure is made.”

“If Bushra Arain and ALPU members don’t speak up for their rights no one else will help them,” said Maqsood Ahmed.

Bushra added to this, “We will continue to speak up for our rights because no one is willing to give them to us despite the court’s order. Our union will keep fighting.”