Pakistan Rural Women’s Health Empowerment Program

Summary

In 2024, The An-Nisa Foundation committed to transform climate-resilient community spaces into Women’s Health Empowerment Centers that will serve as hubs for health education outreach and services to 50,000 women in 50 rural Pakistan communities by 2028. Doctors will create context-specific, culturally sensitive health videos that will be shown as part of health outreach efforts. The Women’s Health Empowerment Centers will also serve as an affinity space, where women will receive health education and ultimately assure timely utilization of local health services including cancer diagnosis and treatment. To facilitate these community conversations and extend the reach beyond the physical community centers themselves, 120 paid Lay Health Workers (LHWs) will be identified and trained to disseminate health education messages effectively and ensure appropriate and timely access to further medical care. A hospital care coordinator will also see women through the entire cancer continuum: education, awareness, screening, detection, follow-up and survivorship.

Approach

The An-Nisa Foundation, through partnership with the Heritage Foundation, commits to transforming four climate-resilient women’s center spaces into Women’s Health Empowerment Centers that will serve as hubs that extend health educational outreach and services to 50,000 women in 50 Pakistan communities by 2028. The Heritage Foundation, led by renowned female architect Yasmin Lari, extends vital assistance to communities affected by climate disasters, empowering them to construct homes, schools and women’s centers, resilient to floods and earthquakes.

Efforts under this commitment will improve screening, early detection and use of breast cancer treatment among rural women in Pakistan. Within the four participating centers, doctors will create context-specific, culturally sensitive health videos that will be shown as part of health outreach efforts. The Women’s Health Empowerment Centers will also serve as an affinity space, where women will discuss health issues, share experiences, and support each other.

To extend the reach beyond the community centers themselves, 120 paid Lay Health Workers (LHWs) will be identified and trained to disseminate health education messages effectively and ensure appropriate and timely support to access to further medical care. Dependent on local needs and resources, LHWs will cover topics such as hygiene, nutrition, reproductive health, maternal health, breast examination, and menopause. By using the LHW model, the program will tackle prevention while also ensuring timely identification and referral of women to the District and Civil Hospitals if specialized care is needed.

Furthermore, additional engagement and support will be provided so as to ensure women access the care they need, when they need it. Five breast cancer surgeons from nearby hospitals will conduct in-person outreach and establish direct care links with the community centers. A hospital care coordinator will also be hired to see women through the entire cancer continuum: education, awareness, screening, detection, follow-up and survivorship.

Action Plan

Q3 to Q4 2024: A thorough assessment of the local community to identify potential Lay Health Workers (LHWs) and evaluate the current healthcare infrastructure, including existing resources and gaps in women’s health services, will be completed. LHWs will be recruited according to selection criteria that takes into consideration their commitment to the community, communication skills, and willingness to undergo training.

Q1 2025: An online training program for LHWs will be developed and implemented. Training will be tailored to the needs of the community and the specific challenges faced by women in accessing healthcare.

Q2 2025 to Q3 2027: LHWs will provide services to women. The performance of LHWs will be continually monitored through reach indicators and feedback from LHWs and their clients. In addition, monthly educational sessions for community women, featuring video lectures on identified women’s health issues, will be conducted. Feedback on session feasibility and women’s attendance will be considered for continuous quality improvement.

Partnerships with local healthcare facilities, government agencies, and other stakeholders will be developed on an ongoing basis. As new partnerships are formed, a plan to ensure the long-term viability of the program will be developed. This includes strategies for capacity building and succession planning for Lay Health Workers. This model can be replicated and scaled to other communities facing similar challenges. Policymakers, health authorities, and other stakeholders will be engaged in discussions about the value of Lay Health Workers and the importance of investing in community-based healthcare initiatives.

Background

Pakistan is one of the most vulnerable nations to the adverse impacts of climate change, despite contributing less than 1% to global carbon emissions (Fahad and Wang 2020) . The country faces frequent floods and droughts; the 2022 floods in Pakistan brought unprecedented devastation, submerging nearly a third of the country, affecting 33 million people and displacing 7.9 million (OHCA 2023) . These climate-related disasters, compounded by limited adaptive capacity due to high poverty rates, limited financial resources, and inadequate infrastructure, contribute to poor health conditions (Hussain et al. 2019, Somani et al. 2023) . Rural populations, making up 62% of the total population, are particularly at risk due to limited access to essential services like healthcare and education with significant rural urban disparity ratio (Khan & Hussain 2020) . Furthermore, factors related to gender inequality such as safety concerns, transportation constraints, financial dependency, and cultural norms lead to disproportionate impact of climate change on women’s access to health (Sorensen et al. 2018) .

While rural women in Pakistan are at greater risk for poor health outcomes across disease categories, urban-rural disparities in women’s health are particularly evident as it relates to breast cancer, which affects 1 in 9 women in Pakistan (Menhas 2015) . For women in rural Pakistan, the breast cancer mortality rate is not following the national trend of decreasing mortality, but rather is stagnant or even increasing (Zahnd et al. 2018) . Rural women are more likely than urban women to be diagnosed with late-stage breast cancer, largely due to poor individual-level knowledge of health (including how to conduct self breast exams) and delayed treatment seeking (NIH 2022) . With limited information about health and accessible health resources, rural women are at a disadvantage in accessing critical screening and treatment services for both communicable and noncommunicable diseases like breast cancer.

Progress Update

Partnership Opportunities

The An Nisa Foundation aims to highlight women’s health challenges in rural Pakistan and invites other organizations to join them in this critical endeavor. The An Nisa Foundation welcomes support from funders, the government and the health sector in several key areas:
Funding: Financial resources are essential to scale the program, train more Lay Health Workers (LHWs) , and expand health education initiatives.
Referral Resources: Collaboration with government health agencies and hospitals to facilitate a referral pathway, ensuring that women in need of specialized care can access appropriate medical facilities promptly.
Training and Capacity Building: Assistance from healthcare institutions to expand advanced training for LHWs and healthcare providers in rural areas, enhancing their ability to address complex health issues.
Infrastructure Support: Support in improving healthcare infrastructure in rural areas, including the provision of essential medical supplies and equipment., The An-Nisa Foundation is open to sharing its expertise, educational materials and Lay Health Worker training to complement and support aligned efforts in supporting rural women’s health in Pakistan. This commitment will facilitate the connection of resources such as knowledge, expertise, and experiences. Furthermore, increased awareness about health issues among rural populations will encourage earlier healthcare-seeking behavior, thus significantly reducing the burden on the health system, reducing healthcare costs and improving health outcomes.