The lady health worker program in Pakistan--a commentary

Internationally, approximately 4 million neonatal deaths occur each year, the majority within the first few days of birth in communities with inadequately designed health systems.1 Value is defined as patient health outcomes per dollar spent.2 Neonatal deaths account for an increasing proportion of child deaths.1 Newborn survival is related to Millennium Development Goal (MDG) 4 for child survival and is also related to MDG 5 for maternal health as the interventions are closely linked.3 This often requires health system strengthening.1,3 Health-care challenges in developing nations are several:3,4 there is a lack of basic health-care services and of health-care professionals, insufficient Infrastructure, incompetent health education, lack of understandable association between health service needs and education, and lack of continued medical education leading to out dated treatments. The financial health situation is generally: low per capita incomes (GDP); poor health status indicators; inadequate budgets and lack of reliable funding; ineffective implementation of health-care practices due to inadequate technical skills and capacities; poor knowledge and practice of social health insurance; poor understanding on the link between health, poverty and economic growth.4 The health status of the people of Pakistan is well below the averages for all low-income countries in key indicators.4–7 In Pakistan, a typical district health infrastructure comprises basic health units, rural health centres and a referral hospital. However, in many rural settings, staffing levels are inadequate and referral …