Engaging women to reach women in Pakistan
Pakistan is the country with the fifth lowest gender-related development index globally. Women are disproportionately affected by eye problems in Pakistan. According to the IAPB vision atlas, around 55% of all visually impaired people in the developing world are women or girls, and one of the main contributing factors to this is the poor access of women to eye care, and their poor understanding of eye health. Literacy rates are commonly lower amongst women than men. The recent economic survey undertaken in 2017 shows that in Pakistan, 70% of men are literate compared to 48% of women. Literacy rates and health behavior are interlinked. In addition, the health of men and boys is often prioritized over the health of the women in a family, because of the commonly higher earning power of men compared to women.
With a rapid increase in the prevalence of Diabetes Mellitus (DM) in Pakistan, Diabetic Retinopathy (DR) is also on rise in the country. As Diabetes and Diabetic Retinopathy are public health issues that require continuous management and treatment compliance, women who have poor access to treatment are the most vulnerable.
To reach out to women in particular, we at Sightsavers involved Lady Health Workers (LHWs) in our Diabetic Retinopathy project. LHWs are the biggest primary health care work force in Pakistan. They have direct access to the people in the communities that they serve. They cover the communities where they live so there is already a high level of trust between patient and LHW which is essential if treatment is to be accepted and advice to be taken on board. LHW visit families in their homes, addressing the problems caused by lack of education which often lead to poor health seeking behavior.
The LHWs are playing a key role in disseminating information regarding diabetes, its potential complications on the eyes and available services. They also use IEC materials about diabetes and Diabetic retinopathy and disseminate these in the communities. As LHWs have a direct access to each family, they are able to interact very regularly with women. Through this regular interaction, they also motivate women to comply with treatment and manage their DM and DR by changing their daily habits. Moreover, these LHWs are trained to refer all the patients at risk to appropriate health facilities for further diagnosis and treatment.
The project statistics prove that the strategy to engage women health workers to reach the women in our communities work well. Out of the total people screened for DR, 57% were females. Out of these, 56% were identified with DR and 51% were identified with STDR. Due to the efforts and increased knowledge of the LHWs, our referral rate has increased from 5.4% in the project first year to 47.6% at the end of the project’s third year. We anticipate that this will further increase in the next two years of project. The LHWs are in regular contact with the female DM patients and ensure that DM control and counselling about diet and lifestyle is continuously given. These measures helpful in preventing DR to develop and STDR to worsen further among the women.
Senior Programme Officer
 “S. Maher, M. Zahid Awan, Nabeel Manzar and M. Saleh Memon. Prevalence of Type-II Diabetes Mellitus and Diabetic Retinopathy: The Gadap Study. . J Pak Med Assoc2010, Vol. 20 (8): 528-532”.