Behind the mud walls: the role and practice of lady health visitors in Pakistan.

Lady health visitors (LHVs), as a specific cadre of health care provider, have existed in Pakistan since 1951. They provide a variety of services to urban and rural communities, including basic nursing care, maternal child health services, and training of community workers. Our purpose in conducting this study was to provide a broad description of LHVs and their practice in Pakistan. A descriptive exploratory design using the qualitative technique of interviewing was considered the most appropriate choice for the study given the lack of literature related to LHVs. A purposive sample of 52 LHVs were interviewed located in both rural and urban areas of the four provinces in Pakistan along with the Northern Areas. The major theme emerging from this study was that of "marginalization." LHVs aligned their practice with medicine yet were originally registered with the Pakistan Nursing Council and had 1 year of midwifery training. LHVs also differentiated their practice from nursing by clearly demarcating the role of registered nurses (RNs) to the hospital, whereas they as LHVs served the community. Confidence that they were making an impact within the communities was apparent. However, frustration at the lack of career mobility was evident along with the desire for strengthening their basic 2-year LHV education.