Fouzia (left) explains method choices to a mother.

Fouzia – a Lady Health Worker (LHW) from Hussainabad in Hyderabad, Pakistan – can rightfully be described as a superhero in her community. With an impressive 14-year track record as an LHW, Fouzia has been at the forefront of delivering essential services, including family planning counseling, to those in need.

Her operational zone extends within a 5 kilometer radius from the government dispensary, where the majority of residents are living in poverty, with an average of nine children per family. The men predominantly work as daily wage laborers or beg for a living, while the women find themselves confined to the role of perpetual child-bearers and/or homemakers. Some families in these slums were originally nomads or internally displaced because of natural disasters. Faced with day-to-day survival struggles, health awareness can be the least of their priorities, let alone family planning. Fouzia, fondly known as ‘Fouzia baji,’ has dedicated 14 years of her life to these communities, nurturing a strong rapport as she engages residents.

Despite the usual initial resistance, Fouzia’s compassionate approach and community involvement gradually opened doors to family planning acceptance. Empathy for women who lack autonomy over their lives, particularly in matters of childbearing, fueled her determination to make a positive impact.

While she and her team were already engaged in counseling in her own and extended catchments, a turning point came with the arrival of The Challenge Initiative (TCI) in the Hyderabad district in September 2022. Fouzia was nominated by the District Health Management Team to attend a workshop building the capacity of Community Health Workers (CHW) in family planning Counseling, which is also one of TCI’s high-impact practices (HIPs). After the workshop, Fouzia felt empowered to extend her reach into new villages outside her catchment area. As a designated CHW for Hyderabad, she started generating demand for TCI-supported Family Health Days and bringing in clients for family planning and reproductive health services.

Fouzia (left) at a TCI capacity building workshop.

The dispensary Fouzia is associated with, unfortunately, had commodity stock-outs, an issue that is not within her purview. Despite that, she kept educating women about family planning and bringing them to the facility for service delivery. At the same time, TCI was strongly advocating with the Department of Health and Population Welfare to address commodity shortages faced during Family Health Days. Through rigorous and regular meetings, facility staff and DOH members realized shortcomings in their data management practices and began to improve inventory management, the quality of their data, and, ultimately, the shortage issue.

Meanwhile, Fouzia continued to generate demand through her effective counseling and interpersonal skills, and achieved an astounding milestone of attracting 500 clients in just one month. This success is not only a triumph for primary healthcare but also a testament to the extraordinary impact an LHW like Fouzia can have in her community. Her achievements were recognized by the DOH as well and she was awarded a cash prize for a job well done.

When asked about her approach to counseling couples, Fouzia shared this story:

 In the Indus slum area, I encountered a mother with 13 children, whose husband was initially against family planning. My counseling not only covered various short and long-term methods but also emphasized the significance of the mother’s health, her role in the family’s well-being and overall household management. Through this intervention, the mother, supported by her mother-in-law who trusted me, chose to undergo implantation at the dispensary.”

Today, this mother is leading a better life, relatively free from the fears of unwarranted pregnancy and managing a large family through daily wage labor and children begging for money. Fouzia’s efforts have not only transformed individual lives but have set a course for improved well-being within her community.