Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Public Policy

First Advisor

Amy E. Smith

Second Advisor

Amit Patel

Third Advisor

Courtenay Sprague


This study investigates the challenges faced by Lady Health Workers (LHWs) and the strategies they have employed to overcome gender-related barriers in delivering healthcare services within low-income communities of Lahore, Pakistan. Additionally, it explores the challenges encountered by the LHWs during the COVID-19 pandemic and their adaptive responses. Through a critical interpretivist approach, this study employs qualitative methods to capture the lived experiences of LHWs. Focus group discussions and one-on-one qualitative interviews were conducted with 31 LHWs from six neighborhoods in the district of Lahore; namely Chuburji, Chung, Jia Musa, Maraqa Village, Mazang and Muhammad Nagar Secondly, five one-on-one semi-structured interviews were conducted with a mixture of government officials and policy experts from Integrated Reproductive Maternal and Newborn Child Health & Nutrition Program (IRMNCH & NP), World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and Rahnuma Family Planning Association of Pakistan. The findings reveal challenges at various levels: institutional, community, household and individual. At the institutional level, they grapple with issues such as overwork, inadequate compensation, resource scarcity, and workplace disrespect. In their community roles, challenges arise from interactions, mobility constraints, and the complexities of relationship building. At the household level, LHWs navigate the balance between managing household responsibilities and childcare, familial influences on their work, and the financial imperative to continue working. At the individual level, the results show the multidimensional nature of factors influencing the identity of LHWs, such as their professional development through this job and the financial independence and respect they gained as a result. Finally, the study sheds light on the multiple ways the LHWs overcome the challenges they encounter, by proactively engaging with the community, leveraging personal connections to build new relationships, and involving local religious leaders to motivate the residents to rely on their services. Attaining financial independence and trainings in their jobs serve as crucial factors in empowering the LHWs. This dissertation contributes to the scholarly literature on the vital contributions of community health workers in South Asia, especially in light of a global health crisis. The study provides key policy recommendations aimed at enhancing healthcare delivery to marginalized groups in Pakistan, and other developing nations.


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