Executive Summary

Peoples Service International (PSI) is a global union advocating for the rights of public sector workers. For a long time, PSI has supported its affiliated unions in Pakistan, including the All-Sindh Lady Health Workers and Employees Union (ASLHWEU) and the Punjab Lady Health Workers Organization, as well as Nepal Health Volunteers Association (NEVA) and Health Volunteers Organization of Nepal (HEVON) in Nepal, in securing their legal rights. Especially, during the COVID-19 pandemic, when community health workers (CHWs) not only administered vaccinations at COVID centres but also mobilized and motivated communities to get vaccinated, PSI helped them in establishing the Community Health Workers Commission to protect CHWs' rights and safety.

Ironically, in South Asia, governments have failed to provide basic health facilities and health education to people, especially living in rural and far-flung areas. To fill this gap, millions of CHWs undertake this responsibility in Pakistan, India, and Nepal. However, these CHWs, who effectively raise awareness about maternal and child health, often are deprived of their basic rights as workers. In India and Nepal, they are recognized as Community Health Volunteers rather than Community Health Workers. In contrast, Pakistan’s Lady Health Workers (LHWs) have been recognized as government workers, thanks to their persistent and unparalleled struggle spanning years.

When LHWs of Pakistan succeeded in getting their right as public sector employees, a need was felt to have an exchange visit of Nepali community health workers to Pakistan. Thus, PSI with the collaboration of Workers Education and Research Organization (WERO) in Pakistan arranged this visit.

The basic purpose of the 5-day visit of Nepali Community Workers to Pakistan from Oct 29, 2023 to November 02, 2023, was to give opportunity to Nepali community workers to learn from the experience and struggle of 125000 LHWs of Pakistan, who successfully secured their recognition as government workers and gained basic legal rights such as pension, maternity leave, and other benefits after a long and arduous struggle. Aimed at replicating Pakistani LHWs’ success in Nepal, Nepal’s CHWs wanted to learn:

1. How LHWs in Pakistan organized their workers and what strategies they adopted at national level to regularize their jobs.

2. How did they mobilize their members.

3. The tools/strategies they used to wage consistent struggle.

4. How they engaged other stakeholders, including trade unions, civil society, and the media.

5. The strategy they adopted to get their union registered.

6. The current status of their struggle and the demands they are still fighting for.

7. How unions from both the countries can collaborate to launch a joint struggle to ensure that CHWs in other countries are also recognized as "workers."

While the five-day deliberations brought many strategic points for struggle, one important aspect which emerged from the interaction with trade unions from other sectors, such as fishermen community, was that traditionally, trade unions have focused solely on workplace issues, neglecting community concerns. It's imperative for unions to broaden their scope and advocate for community issues alongside workplace ones. Unlike workplace-specific issues tackled by organized women, community-organized women address a wider array of concerns. So achieving inclusivity within unions hinges on addressing these broader community issues, such as healthcare, education, and water access, which disproportionately affect women. Capacity-building, trainings of members, raising awareness among the general population about everyday challenges and strive to resolve them through collective action, and seeking women's support, are some of the key points through which unions can advance their agenda.

In Pakistan and across South Asia, the Lady Health Workers' movement exemplifies union strength and research collaboration across provinces in Pakistan, Nepal, and India. International solidarity through affiliations with organizations like PSI and WHO, played a crucial role in advancing these goals.

While many lessons were learnt during the five-day meeting, one key finding was to hold another all-Pakistan conference sometimes in 2024, to create a powerful wave of change. This change will culminate in forming a federation of all LHW unions across Pakistan through which LHWs can exert pressure on both provincial and federal governments and adopt an organized approach to lobbying.

Organizations who supported in this visit:

PSI is the voice for public services and the workers and unions which deliver them. PSI is part of the original movement of Internationals: united groups of socialists, trade unionists and workers created to link the struggles of the working class around the world. Since its founding Congress in 1907, PSI has grown into a truly global organization, with regional offices on every continent. From its Head Office in Ferney Voltaire, France (on the border with Geneva, Switzerland), its team continues this legacy.

 Nepal Health Volunteers Association (NEVA)

NEVA was established on February 15, 2010, from first national conference of health volunteers. It aims to safeguard the rights of health volunteers trained with skills to give polio vaccine and vitamin and midwife and working in all parts of the country. The union is registered in the Department of Labour. The first national Convention of the union was held on March 5, 2011. Currently, NEVA's President is Sis. Gita Devi Thing Paudel.

Health Volunteers Organization of Nepal (HEVON)

HEVON was established on January 07, 2018. The union has been registered in the Department of Labour. HEVON strives to empower FCHVs to advocate for their rights and welfare, including demanding minimum wages and recognition as workers not volunteers. Currently, HEVON's President is Sister Basanti Maharjan.

Workers Education and Research Organization (WERO)

WERO works on labour and citizens issues including labor, education, peace and child rights, provides basic utilities to the working class and also works for good governance. It also works with marginalised sections of society that include women, minorities and youth. WERO consists of dedicated experts in development work in various fields dealing with labor, women, peace, minorities, media, education, and community health.

DAY ONE: October 29, 2023

On the first day of the visit, an informal meeting with the leadership of CHWs from Pakistan and Nepal took place. Participants were briefed about their stay and the agenda for the next four days deliberations. To overcome the language barrier, a translator was arranged to ensure smooth communication.

DAY TWO: Oct 30, 2023

The second day of the session started with the introduction of participants as an ice breaker between Lady Health Workers (LHWs) of Pakistan and Community Health Volunteers (CHVs) from Nepal to get acquainted with each other.

Following participants were from NEVA and HEVON of Nepal:

1. Ms. Gopi Raut - Treasurer- Health Volunteer Organization of Nepal (HEVON), a lady health workers organization in Nepal. She has been working as a health volunteer in Lalitpur Metropolitan City for thirty years.

2. Ms. Basanti Maharjan - President - Health Volunteer Organization of Nepal (HEVON)l She has been working as Community Health Volunteer (CHV) since 2001.

3. Ms. Sita Lama Gole- Vice President - Nepal Health Volunteers Association (NEVA), working in Kathmandu Metropolitan City, Ward No. 15, as a community health volunteer since 1998.

4. Ms. Totala Kumari Dahal, Khai Ghat, a city in the Udaipur district of Nepal,   Chief of Delegate Council - Nepal Health Volunteers Association ( NEVA), working as CHV since, 1991.

5. Ms. Saraswati Subedi - Member- Nepal Health Volunteers Association (NEVA), working as a CHV since 1992

6. Ms. Radha Lama, from Kathmandu, Member-  Health Volunteer Organisation of Nepal (HEVON), have been working as CHV for a very long time.

Participants from Pakistan:

1. Bibi Jan Baloch, Baluchistan, province of Pakistan. Working as a Lady Health Supervisor in the National Lady Health Workers Program since 2001.

2. Haleema Laghari, Central President of All Sindh Lady Health Workers and Employees Union (ASLHWEU).

3. Zulqarnain, media representative of ASIHWEU in Pakistan, working with the Union since 2012.

4. Shama Gulani, Sindh, General Secretary, ASIHWEU

5. Irum Fatima, Faisalabad, Chairperson, Punjab Lady Health Workers Union, working as a LHW for 22 years.

6. Parveen Ashraf, Additional General Secretary of Punjab Lady Health Workers Union.

7. Shazia Bano, District President of Hafizabad, Punjab.

8. Mahjabeen Afzal, Mansehra, KP, LHW since 2015.

9. Tasneem Zaman, Mansehra, KP, working as a LHW for the past nine years.

10. Hawa, District Thatta, Province of Sindh.

11. Shamim, District Tando Allahyar, Province of Sindh.

12. Rashida Sulaimani, LHW from Baluchistan, Provincial Deputy General Secretary and Provincial Media Coordinator.

13. Mohammad Karim Zehri, Provincial General Secretary of the Baluchistan Ladies Health Workers Union.

14. Parveen Safi, President, Lady Health Workers, Quetta District, working as a LHW since 2008 and was given the charge of LHS in 2012.

After the introduction of the participants, the session started with the showing of documentaries on the struggle of All Sindh Lady Health Workers and Employees Union (ASLHEU), including a film titled "Behind the Mask," which was produced during COVID-19. This film highlighted the journey and struggle of LHWs worldwide.

A Case Study shown in the documentary

“I was the first lady health worker in my village. My initial salary was 1200 rupees, and my happiness knew no bounds when I first saw a 1000 rupee note because I had never seen one before. As we continued working, it became clear that the pay was far less than our workload. Often, we wouldn't receive our salaries for three months at a stretch, but we kept working. In addition to salary issue, harassment in the field was a great challenge for us. We faced verbal abuse and harassment from the community but we kept working. We went to the Islamabad Parliament House and even the Supreme Court to demand regularization of our jobs and timely payment of salaries. It's hard to believe that I once worked in the fields and now, as a lady health worker, I am fighting with my colleagues for our collective rights.

Session II: Organizing Community Health Workers in Pakistan and Nepal: Situation, organizing Strategies, achievements and current issues

In this session the speakers from Nepal and Pakistan shared situation, organizing strategies, achievements and current issues faced by community health workers

Haleema Laghari, Central President of ASLHWEU, in her presentation, gave the background of the LHW program in Pakistan which was launched under the government of Pakistan People's Party by the then Prime Minister Benazir Bhutto (late) in 1994. The purpose of the program was to improve maternal and child health and empower less educated women in the community, enabling them to identify and address health issues while becoming financially independent. Majority hailing from poor background, these LHWs drew an initial meagre salary of Rs 900, with an annual increment of 100 rupees. At that time, financially well-off families wouldn't allow their women to join this program, believing it beneath their dignity.

Given no holidays, not even on Eid, these LHWs, used to work 24/7, yet they were looked down upon by their community. In 2008, a nationwide association, called the National Program was launched which later was named as the Lady Health Worker Union. Under the National Program, LHWs fought for their rights. Following the 18th Constitutional Amendment, health became a provincial subject, which gave birth to the All-Sindh Lady Health Workers and Employees Union (ASLHWEU) in 2016, with support from the Workers Education and Research Organization (WERO) and Public Services International (PSI), a Global Union Federation of more than 700 trade unions representing 30 million workers in 154 countries.

Fraught with challenges, with minimal to negligible pay and overwhelming workloads, LHWs were given no safety at their workplaces. Like women in other fields, LHWs also withstood grave challenges, they were given no protection and benefits, and faced sexual harassment, domestic and societal abuse, torture and even martyrdom of some in polio campaigns. However, in all four provinces and Azad Kashmir, LHWs’ continued their activism with commitment which increased respect for their efforts, attracting support from organizations like PSI and WERO. With their help, they initiated their campaigns, did extensive lobbying, held meetings with health ministers, the Director General of Health, various politicians, social workers, and civil society members to convey their plight, seeking recognition and support for their rights. Through networking, leveraging support from lawyers' associations, and media, their persistent struggle since 2008 finally bore fruit.

Giving the history of LHWs struggle, she said, their first major protest took place in Islamabad, followed by others in Karachi and Islamabad, where they faced baton charge, water cannons, arrests and were charged with terrorism. In 2012, the Supreme Court's suo-motu action led to the regularization of LHWs jobs, a victory achieved after many sacrifices, leading to enhanced salaries and a COVID allowance. PSI and WERO have been instrumental in these achievements.

Despite regularization, LHWs still have no service structures, time schedules, gratuity, or holiday mechanism for retiring members. To address these issues, they aim to establish a national federation or an alliance with the support of PSI and WERO and also expand their membership to strengthen their activism.

She said the key to the strength of her union is democracy which involves consultation with all members through whatsapp groups in any decision making to ensure collective agreement and ensuring all members are on board.

Speaking on the occasion, Aisha Bahadur, PSI's Project Officer, from PSI Head Office, emphasized the global struggle for community health workers’ rights. She termed the expectation that women’s work in primary health care, mother and child care, and elderly care should be unpaid, as unfair. Aisha stressed the need for proper wages, training, resources, and a safe, harassment-free work environment for community health workers around the globe. She said PSI’s support extends beyond South Asia to Africa, advocating for fair treatment and compensation worldwide.

After Aisha’s speech the forum was opened for mutual consultation. In which Nepali and Pakistani community health workers shared their experiences. Nepali LHW leader Basanti Maharjan advised community health workers to coordinate with political leaders and bureaucrats to get their rights. Showing her concern on the treatment of women in Nepal, she felt the need to change the statuesque for women in Nepal. She said they must learn from their Pakistani counterparts, as the working style in Nepal is entirely different from that of Pakistan.

Haleema Laghari informed that initially their issues were overlooked by politicians, but it was after persistent protests and media support, that their issues were taken seriously, compelling politicians to engage with us. “The cultural and religious milieu of Pakistan, where women rarely step out for protests, highlighted the significance of our street demonstrations, unified us and conveyed the seriousness of issues to leaders.”

She further said, despite Supreme Court’s favourable ruling, injustices persisted, such as discrepancies in pay scales. LHWs demanded recognition of their seniority from 1994, when the program was launched but it was overlooked. “If the government fails to negotiate fairly, we plan to file a case in the Supreme Court in Karachi,” she said and added that through relentless efforts, solidarity, and external support, they will continue to strive for better conditions, fair treatment, and recognition of their indispensable work as LHWs.

Shama Gillani, Secretary ASLHWEU, and working as LHW since 1996, recalling her meeting with her Nepali friends in 2016, said she had invited them to Pakistan and now when this visit has been arranged, they will share their achievements and problems and will come up with solutions to resolve these issues. She also showed her concern for Nepali sisters who are still working as volunteers since the ’90s. She added that the LHW program’s launch in Pakistan coincided with Prime Minister Benazir Bhutto's tenure, providing some political support as well to the cause.

Iram Fatima, Chairperson of Punjab Lady Health Worker Union, stated that their union is the largest in Punjab, established in 2014 by 35 women. Today, it has nearly 99% women workers. After registering with the Labor Department in 2017, they got affiliation with PSI in 2020, growing from 500 workers to 700 in 2022. She expressed her determination to reach the target of 20,000 members. They have established centres in 7 districts of Punjab and plan to expand to all 36 districts of the province. She vowed to continue fighting for their rights, including fair salaries, repair costs, and petrol allowances for lady health supervisors and recognition of their union at state level.

Ms. Sita Lama Gole, VP-NEVA, lamented that they are recognized by the government as community health volunteers. Their uniforms is saree and some of her colleagues have been working since 1987 without being recognized as workers. She also expressed her hope to learn from this exchange of visit and take the learning back to Nepal.

Ms. Totala Kumari Dahal, while paying her gratitude to Zulfiqar Ali for arranging this visit, showed her keenness to learn from exchange visit program from their Pakistani counterparts.

Bibi Jan Baloch from Balochistan, assured her Nepali friends that they will learn a lot from Pakistan and this learning will benefit them in the future.

Parveen Safi, President of LHWs, Quetta District, welcoming her Nepali friends, said they are also facing many challenges and are fighting for their rights. She hoped that together, they will achieve their goals.

On the second day the post lunch session was on the exchange of experiences, in which participants discussed Situation, Organizing Strategies, Achievements and current issues. They delved into discussion on two main questions: 1) How the struggle began 2) How to build unity within the union

Halima Leghari:

Answering the first question as to how the struggle began, Haleema Leghari said they worked tirelessly for 18 years without regularization, with no regular salary and extended hours of working within the community which affected their families as well as their own mental and physical health. Sometimes, they didn’t receive salaries for months. Despite working hard, enduring mental stress, and facing a lack of trust from their families due to the nature of their jobs, they finally reached a point where they started thinking of taking concrete action.

As a first step they started collecting the contact numbers of lady health supervisors from across the province and began disseminating messages. They reached out to different supervisors in various districts and thus initiated their movement nationwide. People soon realized that LHWs deserved regularization like other government workers who receive regular salaries, have a service structure with facilities and retirement benefits. We organized meetings and gradually formed a group of like-minded people. This movement gained momentum nationwide in such a way that it not only attracted women in Pakistan but globally. She said they proved themselves more resilient than men in their struggle. The government and the health department underestimated them, thinking they wouldn’t stand even for an hour in the sun or would resort to street protest. Dispelling their notion, we held sit-ins for two or three days straight, facing state oppression and violence, and eventually, we achieved results.

On a comment by a Nepali participant that Nepal's situation differs from Pakistan's, Haleema said the challenges are similar. Every initiative meets with difficulties at the start. Their issues weren't resolved in days or weeks but it took years of struggle to resolve these issues. Started in 2008 the movement saw some success in 2012. During these four years, they did persistent efforts, balancing their jobs with protests and lobbying.

Haleema further said that they were initially hired as daily wagers and were told that they will not be regularized. However, they continued their struggle and convinced the government that as per Pakistan’s constitution, an employee should be made permanent after three years of service. With 18 years of service, they are entitled to a regular job. We convinced the political leadership in the government by citing their vote bank and the empowerment of women as part of their manifesto. We also convinced them through statistical records of polio cases, which numbered in thousands in 1995, had been reduced to a few thousands due to the hard work of LHWs. We also told them that there is an increase in the use of contraceptive prevalence rate (CPR), reduction in the population growth rate, and decrease the infant mortality rate (IMR). We asked them how they can dismiss such dedicated workers who had helped Pakistan achieve the Millennium Development Goals. We told them that LHWs are the backbone of the health sector, without them, it would be difficult to have healthy children born in the country as they provide health education to mothers.

Adding to the challenges of maintaining unity, Shama Gulani said, starting a movement and traveling from one place to another for the cause, the biggest challenge is often financial. Maintaining unity within the union also requires financial support for attending meetings etc. They collectively addressed these issues and supported each other financially. They spent their own money on this movement, even selling their jewelry to fund it.

Mir Zulfiqar Ali:

ASLHWEU adopted two-prong strategy. Firstly, organization, meaning coming together with a common purpose. This should not be for personal gain but for a higher cause that unites everyone around a common agenda. For Pakistan's LHWs, the agenda was to be recognized as regular government employees. They fought for this cause and achieved it. Second important point was to get some financial strength, for this, it is necessary to make everyone a member of the union and collect dues from all members. This is an important issue as relying on external funding can lead to outside influence on decisions and may affect the union’s independence. Collecting dues from members ensures accountability to them for how the funds are utilized. It's important to explain the significance of these dues to the members and persuade them to contribute a small amount monthly to the union.

Mohammad Karim Zehri from Balochistan

Balochistan’s problems are unique and perhaps more severe than in any other region of Pakistan. Strong tribal system coupled with the vast geographical boundaries require any union or party to have a solid platform to operate from.

LHWs in Balochistan began their struggle at the district level, facing challenges due to strong tribal system and religious inclinations, which make women’s mobility very limited. In 2008, when a few women were called for a district-level meeting, we faced resistance from local tribal leaders. Despite financial difficulties, we formed a union and a committee with only few initial members. For a year, we continued working in this manner. In 2009, we drafted our union’s constitution, which is essential for registration. This marked the beginning of our journey. We then created membership cards and currently we have 7,000 members in Balochistan. In 2010, during a lobbying effort with Chief Justice Iftikhar Chaudhry, he promised to take suo motto action, if we resort to protest. We protested in Lahore and continued our struggle by connecting with other unions across Pakistan, using our networking in Punjab, Sindh and Kashmir. We won our case in 2012, but the 18th Amendment transferred the budget to the provinces, necessitating further lobbying. In 2013, we held a major protest in the province, marking the first women’s protest in Balochistan’s history. Just six months after this protest, in 2014, we achieved permanent status of LHWs’ jobs. We provided gradings to our workers according to our system. In 2015, we secured 1.45 billion rupees from the federal government for LHWs. Another issue in Balochistan was the inability of family members to receive a deceased worker’s position; we won that case as well. We participated in rallies in Lahore and Quetta and struggled to organize the national program throughout Pakistan.

While adding details of the union dues, Parveen Safi, President, Lady Health Workers, Quetta District, said, they collected 50 rupees per worker each month and maintained a record of expenses. Recently, a worker’s son was killed in a bank, and the union provided all out assistance and hired a top lawyer for the case. In another incident, four LHWs were attacked and killed, yet the government did not acknowledge them as martyrs.

Mahjabeen Afzal from Khyber Pakhtunkhwa (KP) Lady Health Workers Union

Mahjabeen said the LHW union in KP was formed in 2023, and many members are still not regularized, with some not even receiving salaries for five to six months. We face threats that if we continue such activities, we will be terminated. Since forming the union, our higher officials have supported us, and we have organized various protests for salaries and regularization. Despite 10 months of salary delays, four months are still pending. We believe that once a national federation is established, all these issues will be resolved.

DAY 3: Oct 31, 2023

On Day 3, in the first half of the day, a tour to the health houses in Karachi was arranged for the community health workers of Pakistan and Nepal. While in the second half there was a panel discussion on “Women in Trade Union”.

A visit to Health Houses in Manzoor Colony of Karachi, Pakistan

In the first half of the 3rd day of the meeting, Nepali participants and various LHW union members from Pakistan visited health houses in the crowded area of Manzoor Colony, Karachi. Manzoor Colony, located in Karachi East district, is home to diverse ethnic groups, including Muhajirs, Baltis, Punjabis, Sindhis, Kashmiris, Seraikis, Pakhtuns, Hazaras, Memons, Bohras, and Ismailis. Over 95% of the population is Muslims, with small Christian and Hindu communities. Known as "Little Baltistan," about 60% of the land is owned by Balti individuals, significantly shaping the neighborhood.

At the first health house, Nasira Perveen, Senior Vice President of the All-Sindh Lady Health Workers and Employees Union (ASLHWEU) welcomed the participants. Farhat Perveen, a Lady Health Supervisor at the House, briefed the participants about their work with mothers and children. Serving and acting as an intermediary between the community and the formal health system, these LHWs give health education, do vaccination, keep the record of polio vaccines administered to area children, and also look after the maternal and child health.

Farhat Perveen shared her journey, explaining the initial challenges she faced in gaining the community's trust. Over time, as she provided essential services like registering pregnant women in hospitals, monitoring health indicators, and offering postnatal care, the community's confidence grew. Farhat's health house consists of a small room in her home equipped with weighing machines for mother and child, stethoscope, vitamins tablets stock, vaccine preserving boxes, gloves, uniform, record registers etc as well as a small seating area and a couch to check pregnant women. She has established this set up without any financial support from the government. “We are happy that regularization has entitled us to benefits and salaries that is given to other employees but we have immense workload and have to cover a large geographical area. We have regular meetings in the health department, where our performance is assessed.”

Farhat while describing her journey said, “The work of LHWs is generally looked down upon by well off families. Continuous counselling and hard work had to be put in to show why our presence is necessary. Now whenever a mother gets pregnant, the area people contact us and we pay visit and help them in getting them registered in a good hospital, keep a record of their weight and other health indicators and advise them if there is any shortcoming. Once the child is born, we start giving them post-natal care, keeping the record of the child’s weight, height and vaccination,” she maintained.    

The visit to Patras’ Health House was a delight due to its artistic setup. Located on the first floor near staircase, her health house is separated from her living area and features informative brochures in English and Urdu, a clean washroom, and an LED screen for educational videos. Patras, from the Christian community, enjoys immediate acceptance by the community due to the prevalence of Christian nurses in Pakistan. Fluent in Urdu and English, she maintains patient records meticulously and offers support at all hours, often accompanying patients to hospitals at night.

Nepali participants showed keen interest in the Pakistani LHWs' work, noting that in Nepal, similar tasks they undertake are often considered unpaid voluntary work. Translators Sheher Bano and Sister Genny facilitated discussions, answering questions from both the Pakistani and Nepali community health workers.

Panel Discussion on “Women in Trade Union”: An interactive session with trade unions, CSOs and professional bodies

The session was opened by Mir Zulfiqar Ali, General Secretary and Executive Director, WERO, by giving the detail of previous day’s deliberations. After the introduction of the participants, Sheher Bano Vice President, Pakistan Federal Union of Journalists, started her presentation on “Women in Media.”

Sheher Bano, Journalists, Activist, Trade Unionist, Vice President, Pakistan Federal Union of Journalists (PFUJ)

Speaking on the plight of women journalists she said women in media like other fields face immense challenges including, no flexi hours, no trainings, no transport, no separate washrooms/retiring rooms, overtime or extra duty allowance; they have extended hours of work sometimes late-night work, no implementation of ILO’s decent job agenda, gender blind policies and laws but no inspection mechanism. They also face discrimination in medical benefits (sometimes no maternity leave), promotions and other facilities. They often need to prove themselves more than men for equal facilities and recognition. In Pakistan, since 2000, over 150 journalists and other media workers have been killed in Pakistan. (FN Report). Between 2012 and 2022, at least 53 journalists were murdered, out of these 2 were females. Another female reporter was killed after being crushed under the trawler of a political rally she was covering. Very few cases received justice from the courts the rest remained undecided.  

She said decline of print media, not only in Pakistan but throughout the world, resulted in the reduction of female jobs and beats given to them. Before COVID-19 around 3500 journalists were laid off, post-COVID further retrenchment led to 7000 people losing jobs; many channels and newspapers closed and the process still continues unabated.

The 8th Wage Board Award announced after 19 years in 2019, lack implementation in all newspapers. The judges in the Implementation Tribunal for the Newspaper Employees (ITNE) are not appointed on a regular basis which jeopardizes the decision of many cases. Moreover, poor labor inspection system that lacks female inspectors and judges, impact fair treatment at workplaces. Discrimination of females and online harassment in digital media remains unchecked. She also gave some recommendations (See recommendation section)

Nuzhat Shiron, trade unionist, Activist and Chairperson Sindh Commission on the Status pf Women

Nuzhat Shirin highlighted the disparities in public sector organizations' treatment of female employees. When a new male Managing Director or Secretary joins, their office is lavishly decorated, while female predecessors receive no such upgrades. The union office, active during elections, shows no female participation, highlighting gender inequality within the organization.

The 15% job quota for women is never fully implemented, indicating pervasive gender discrimination. Despite repeated reminders, no women are appointed to the sanctioned posts in the Sindh Commission, with some posts given to daily wagers without facilities. The Commission has 20 staff members but only three officers work for the entire Sindh region. Many members are absent, aspiring to become chairpersons. In the Women Development Department, men outnumber women, many positions remain vacant. Women appointed on Grade 16 or 17 remain stagnant without promotions, working under male deputy directors. Currently, there is no secretary in the department, and her own future depends on that appointment.

Women's inclusion in new departments is often half-hearted, and their participation in trade unions and CBAs in government offices is minimal. Many women are unaware they can participate in unions. Basic facilities, like bathrooms, are lacking even at the Sindh Secretariat.

Organizations and departments created for women lack government’s priority and support. Workplace harassment and character assassination of women, poor inspection system and non-implementation of laws due to lack of political will are common issues. Political parties include labor rights in their manifestos but fail to follow through, offering only lip service for recognition without concrete action. The Agriculture Women Workers Union remains unregistered, with farm women doing hard labor while men stay home.

Women in factories often work without contracts, making their numbers hard to track. She said surprisingly when voice was raised for home-based workers, there was a halt in the inclusion of women in the labor force. She also gave some recommendations (See Recommendation section)

Fatima Majeed, Secretary, Pakistan Fisherfolk Forum

Fatima Majeed alarmed on the decline of fisherwomen's businesses and cultural practices. Historically, women's roles in the fishing industry, considered as recognized rights, are now threatened by pollution, mangrove destruction, river damming.

She said traditionally, women manually wove fishing nets, but mechanization has deprived them of their livelihood. Climate change has also reduced islands where women were directly involved. Many fishermen have shifted to urban jobs, leaving behind women who face harsh conditions in prawn processing factories.

In these factories, women endure cold working conditions without separate facilities or proper safety measures impacting their health. They receive lower wages than men, lack timely food and water, and also face humiliating treatment from supervisors. Lack of fishing policy exacerbates issues such as misused nets and environmental degradation. She gave some recommendations: (see Recommendation section)

Haleema Leghari, Central President, ASLHWEU

Haleema Leghari said forming a female-based trade union in Pakistan is an arduous task. In Sindh, 24,000 LHWs waged 18-month long struggle to get their union registered.  Once union was formed, attention was paid to 95,000 LHWs, who were at the forefront of this struggle and faced character assassination, threats, illness, arrests and intimidation.

Citing LHWs example who got their health risk allowance only after protest, she advised Nepali CHWs to join unions if they want to get their rights. She sought the support of senior trade unionists to continue their struggle in the future.

Saeed Baloch, Fisherfolk Society, Secretary

Saeed Baloch appreciated the Nepali CHWs for being highly politically organized, contrasting with Pakistan where union organization, typically associated with left-wing affiliations, has faced deliberate weakening over the years. He said ironically, Pakistan’s economy focusses on the commercial aspect instead of labor force. This aspect has compounded challenges for trade unions. He said, despite recent setbacks, individual leadership and organizational efforts continue to drive our struggle forward. Women, though facing unequal rights in the workforce, exhibit low participation in trade unions. He said increasing female participation in trade unions is crucial as female leaders can advocate for community rights effectively and without a compromise.

Qamr ul Hassan, Director South Asia, International Union of Food Workers (IUF-Pakistan)

Qamar Sahib said his union has organized female agricultural workers in Sindh, forming the Agricultural Women Workers Union to address their specific issues and empower them. Women in rural areas have been mobilized to participate in local government elections to advocate for their needs. They also raised awareness about the danger of reusing pesticide containers and chemical fertilizers.

Over the past 15 years, they insisted inclusion of women in union activities, despite initial resistance, resulting in a significant increase in female participation and leadership roles. Initially, cultural barriers and employer resistance hindered women's employment, but through advocacy and negotiation, they have encouraged workplaces to hire women and ensure their safety and security. Technical training initiatives have been pursued to equip women for skilled positions traditionally dominated by men.

Tasleem, Lady Health Worker, KP, said the resilient LHWs of KP are organizing very fast. Taking lesson from the relentless struggle of Haleema, they are trying to move forward and soon will from a union. She also thanked PSI for their support in unionizing.

Kareem Zehri, Provincial General Secretary, LHWs, Baluchistan.

Kareem Zehri said the ground realities in Balochistan are different from Punjab and Sindh. The literacy rate in Balochistan remains nearly zero, while female education and healthcare are almost neglected. The Lady Health Workers Program, initiated by Benazir Bhutto and adapted from Iran, greatly benefited Baluchistan despite initial salary challenges. Overcoming tribal and religious barriers since 2002, they organized and eventually won legal battle in 2013, securing permanent jobs for 120,000 daily wage workers, a landmark achievement globally.

In 2009, they expanded their efforts across Pakistan, organizing women in Punjab and KP with the support of various political parties and NGOs. Women in Baluchistan exhibited remarkable bravery and resilience, despite educational disparities. They staged sit-ins in Islamabad and Baluchistan, enduring police brutality. He said, organized women are pivotal for advancing movements.

Irum Fatima, Punjab Lady Health Workers Association

Irum Fatima said LHWs in Punjab faced many challenges, but they continued their struggle with the support of WERO and PSI. She vowed to build the capacity of women through training on union organizing, especially in remote areas, to abreast them of their rights. She said there are still some objectives to be achieved, but the unity fostered hy LHWs in all four provinces makes her hopeful of achieving their rights with united efforts.

Habib Junedi, senior trade unionist of banking industry and politician

Habib Junedi observed that Nepal and Pakistan share the common issue of male dominance. He noted that the labor movement in Pakistan has been declining for decades. During its peak, the trade union movement was powerful enough to challenge governments, and the students' movement was also strong, but both have now faded. Similarly, the banking industry once thrived but is now on decline.

Habib Junedi was the president of Pakistan's largest and strongest bank trade union, Habib Bank Limited CBA. At its peak, the union had 18,660 members, but today it has only 135 throughout Pakistan. Attributing this decline to privatization, he said even during the union's peak, it was challenging to include women due to societal and family structures that hindered women's growth. He said the labor movement's decline is not due to a lack of interest but because anti-union forces, supported by the state, are so strong that now it is difficult to bring the movement back to the track where it should be. Pakistan's working class, which numbers 70 million, lacks representation in the parliament and other policy-making bodies, a major factor in weakening democracy. He said unionization and struggle of LHWs is a historic event.

In the banking sector and white-collar jobs, women's participation in trade unions is almost nonexistent. The same applies to private sector mills and factories, where many women work but have no leadership roles in unions. Junedi mentioned a few women leaders from the past but emphasized that half of Pakistan's population remains largely helpless, mostly because of bureaucratic hurdles. Junedi also put forth some recommendations. (See Recommendation section)

Sister Jeni Thapa, Project Organizer of Community Health Workers in Nepal

Sister Jeni who was instrumental in organizing this exchange visit said, the Nepali economy relies heavily on remittances, with many men and young boys working abroad or studying in developed countries. Consequently, the labor market in Nepal is predominantly female oriented, yet they are often marginalized within it. Community health workers (CHWs) in Nepal, all of whom are women, face many challenges. At health posts, all positions are permanent except for CHWs, who work as volunteers without pay, thus a violation of ILO Conventions advocating for fair compensation for all work hours. Some municipalities provide nominal payments, others offer nothing. With support from PSI, unions like NEVA and HAVEN in Nepal have formed a joint forum to advocate for CHWs' rights, recently achieving modest gains such as monthly stipends in certain municipalities.

Their ongoing efforts include lobbying for CHWs to be recognized as registered workers and included in Nepal's social security schemes. Inspired by the successes of LHWs in Pakistan and similar workers in India, Nepali CHWs seek to learn and draw energy from these movements to further their own fight for rights, despite their movement's more recent origins in the 1980s.

Basanti Maharjan, President, Health Volunteer Organization, Nepal

Basanti termed their visit to Pakistan as enlightening and inspiring to see the dedication and hard work of LHWs here, which is worth learning. She said upon returning to Nepal, she feels a renewed responsibility to share these insights and organize more workers to strengthen their collective voice and advocate for their rights within the health system.

She found the level of organization among workers in Pakistan as impressive compared to Nepal. Moving forward, she aimed to collaborate with other unions to expand their reach and organize more community health workers and increase union membership so that all workers, regardless of their political affiliation, can unite to achieve our goals. She shared that their recent success in presenting a unified charter of demands to the municipality demonstrates the power of collective action.

Seeta Lama, Nepal Health Workers Association,

While paying gratitude on behalf of 52,000 community health workers in Nepal, Seeta narrating their journey, informed the session that twelve years ago, they gathered 5,000 signatures to form the Federation of Community Health Workers in Nepal, despite facing challenges like water cannons and tear gas during protests by the police. When they submitted their demands to ministries, they dismissed them on the ground that they were volunteers and their benefits and salaries cannot equal to formal workers.

Despite repeated efforts, the Nepalese government didn’t acknowledge them as workers, even though their efforts contributed to significant reduction in maternal and child deaths in the country. Instead, CHWs sometimes harassed by the community, in one such incident, a community health worker drowned while serving her community, only to be unjustly blamed and assaulted upon her return.

COVID-19 dealt a blow to their membership, forcing them to rebuild from the scratch. She said being a CHW brings increased responsibilities and they are eager to learn from the experiences of Pakistani LHWs and apply these lessons in their work and strengthen their collective efforts.

Aisha Bahadur, Project Officer PSI

Aisha while sharing her observation said historically, Nepal is different from Pakistan as it was never colonized, preserving a deep-rooted tradition. Women's roles differ significantly in Nepal compared to Pakistan, where women are often unseen outside their homes due to cultural norms that segregated genders.

Educating women is pivotal; as the saying goes, "Educate a woman, educate a nation." Economic empowerment and women's participation in the labor force are crucial. However, in Pakistan, many jobs typically held by men, in other countries are performed by women, indicating disparities.

Pakistan lags behind in gender equality and economic participation, with a particularly low score in South Asia. The change begins with education and ensuring skilled employment opportunities for women. Unions can play a vital role by advocating for women's representation in the public sector and demanding fair employment agreements.

Despite impressive efforts by Lady Health Workers (LHWs), challenges persist, including gender gaps in healthcare access. There's a pressing need for improved services and inclusivity, especially in public sectors.

She insisted that creating gender-responsive public services is essential, benefiting everyone while including women and their families. Economic empowerment programs for women can uplift entire communities. Encouraging women's leadership in unions and creating inclusive workplaces are crucial steps towards gender equality.

She said Pakistan has much potential for growth, and collaboration across unions can drive meaningful change.

Mir Zulfiqar Ali, General Secretary WERO

The LHW movement in Pakistan and South Asia has pioneered union strengthening and research initiatives. For the first time, research has been conducted in Pakistan, Nepal, and India, focusing on union capacity building and organization across provinces. Next year, WERO plans to create a national platform, possibly in the form of a federation or alliance and expand this work nationally.

In trade unions, particularly in the media industry, retrenchment is a grave issue. While many, including women, actively participate in demonstrations for their rights, female journalists have limited roles in journalists' unions and Collective Bargaining Agreements (CBAs), and are excluded from decision-making positions, which are usually held by men.

Traditionally, trade unions have focused solely on workplace concerns rather than community issues. Issues like healthcare, education, and water faced by farming and fishing communities, disproportionately affect women, making their support essential for union strength. It's vital to integrate community issues into union agendas to strengthen inclusivity.

International solidarity through affiliations with organizations like PSI and World Health Organization (WHO) is crucial for sharing issues and gaining support.

A one-minute silence was also observed for activist and leader Vero Kohli, who was a strong voice for the farmers community.

DAY FOUR: Nov 01, 2023

On the fourth and final day, on Nov 01, 2023, the participants from both the countries were asked to discuss their future plans.

Opening the session Mir Zulfiqar Ali, General Secretary, WERO, guided the participants that their future targets should be realistic, achievable, flexible for future changes, and in conformity to their collective strength and abilities. He also advised the Nepali participants to gauge their collective strength to exert pressure on the government. If at any point of struggle the authorities resort to baton charge or use of tear gas, they must utilize media, expand their networking, engage with the community, involve lawyers, and leverage collective strength to escalate the cause to the international level. PSI is already aligned with the unions of Pakistan and Nepal and has facilitated our meetings with World Health Organization (WHO), United Nations (UN), and International Labour Organization (ILO). There is need to utilize these partnerships effectively.

Nepali Participants

Narrating their future plans, Nepali participants said they have devised a leadership development training program for new leaders and new members in the union, with a focus on provinces 6 and 7, but extending it to all provinces. The strategy involves submitting a charter of demands at various levels, including ward committees, local, municipal, and district levels. Quarterly lobbying efforts will be maintained with health ministries, totaling four times a year, alongside regular follow-up on submitted demands. Monitoring progress on demands at municipal and ward levels will be done at the district level, while demands will be submitted to provincial health departments twice a year. The submission of memoranda and charters of demand will be tailored to each committee's financial capabilities, and will ensure representation of community health workers in policy-making processes.

They said their top priority is to organize workers within the union, with a focus on increasing membership across 12 districts spanning three provinces: Koshi, Gandaki, and Lumbini. For this they will also encourage the existing members to recruit new ones from within the community.

Dispelling the discrimination of being considered as volunteers, they are planning to change the nomenclature of their union replacing volunteers with workers. After gaining recognition as workers, they will lobby with the Nepali government to include them in the social security scheme. In mid-2024, they plan to conduct an awareness campaign at local level. On 26th December, on Health Volunteers Day, they will launch a mass campaign by submitting charters of demand at all local levels to advocate for the rights of CHWs. Campaigns with volunteers and rallies on Women Workers’ Day will also be organized. To engage members, they will conduct Zoom meetings with provincial committees and hold central committee meetings.

Mir Zulfiqar Ali from WERO

In terms of Pakistan, Zulfiqar said there is need to establish units at both the district and tehsil levels to increase membership, strengthen unions, address workers’ issues, and work towards their regularization. Effective lobbying will be done for issues like pension, maternity leave, and other legal entitlements that LHWs are currently being denied. To this end, it is crucial to engage other stakeholders. For example, if we talk about gender equality, it is imperative first to raise awareness about this and then run a campaign. He said, engaging with the community is also essential since health issues disproportionately affect women and children, who constitute significant majority. If we mobilize this powerful demographic to support our demands, there is a better chance of resolving these issues. The one-year workplan should be made after thorough discussion on how to resolve these problems. Once this workplan with clear objectives is ready, its progress will be reviewed during future meetings, ensuring accountability and follow-up on our objectives.

He advised to keep ground realities in mind that impact our objectives. For example, in Pakistan, the elections are due and the current interim government lacks the authority to decide service structure for 2 to 2.5 million people, so this discussion should be put on hold till next election. However, the union should focus on issues within the current government's authority at the provincial and district levels.

Another important step is to pursue major political parties to include our issues in their manifestos, ensuring that once elected, they will address our issues, including the service structure for LHWs. If the political parties make commitments before elections, we can hold them accountable post-election for their promises.

Future Plans of Baluchistan

Bibi Jan Baloch from Baluchistan said their goal is to strengthen the union by increasing memberships at the district and tehsil levels. They will establish committees in all districts and hold meetings with them to plan future strategies.

To further empower the union, they will maintain strong connections with the committees and raise their voices for their rights. They will also involve other unions in the legislative process to ensure that all employees of the national program receive equal service structures and legal benefits.

She also aimed to strengthen their union and committees by collaborating with trade unions across the country, the purpose is to raise issues at international level. Moreover, they will engage conventional media and social media to send their message to global audience.

Rashida Sulaimani, another participant from Baluchistan added that they have been continuously traveling from district to district for holding elections, staging protests, and enduring shelling and baton charges by police.

Khyber Pakhtunkhwa (KP) Future Plans

The participants from KP intended to increase membership and establish committees throughout the province. They will also work on the regularization of their jobs, service structure, pension and maternity leave, appropriate salary scales and their upgradation. They also vowed to struggle for getting allowances that are currently given to LHWs in Punjab and Sindh but not in KP.

Future Plans of Sindh

The participants from Sindh said their main aim is to accelerate union organizing efforts by facilitating the workers through meetings to instill confidence in them for their tasks. They will hold meetings at the district and provincial levels to highlight achievements and devise future actions. They aim to increase membership by 500 quarterly, totaling 2000 annually, conduct tailor made trainings for their members to enhance skills and knowledge about their rights, lobby with the Secretary of Health and the Director-General of Health to advocate for service structure for LHWs, hold meetings with various trade unions to discuss their issues, engaging with civil society members, and meeting with politicians, selected MNAs and MPAs. Finally, they intend to do follow-up after this conference and involve more international unions beyond Nepal and Pakistan to strengthen their collective voice and unions.

Key Learnings

Secretary ASLHWEU, Shama Gulani and other Pakistani participants termed the workshop successful and truly a common sharing and learning platform, for community health worker from Nepal and Pakistan. They asked representatives from other provinces to do concerted efforts to obtain at least the facilities Sindh LHWs are enjoying at the moment. The LHWs from across Pakistan are unanimous on single agenda-establish service structure.

Nepali participant said the key learning for them from this meeting is the unity among the LHWs of Pakistan, which is unlike in Nepal, where different political ideologies often impact their work. They said they aspire to achieve the same level of unity in Nepal that is shown by Pakistani LHWs, who work towards common goal regardless of their political affiliation.

They said they may not be able to implement all the suggestions and feedback given by Pakistani LHWs, but they will certainly try to adopt as many as possible. Another participant from Nepal said they would like to host this exchange visit next year in Nepal and share their experiences with their Pakistani counterparts and give them  update about their progress and achievements following this meeting.

Sister Jeni said she is carrying with her great learning from the four-day meeting that gave them the opportunity to interact with each other, share their issues and achievements. She said the Nepali participants are carrying with them the great responsibility to implement the lesson they learnt here from their Pakistani counterparts, in Nepal.

In the end, Zulfiqar Ali, General Secretary WERO, thanked the participants Pakistan and Nepal, Aisha Bahadur from PSI and sister Jeni, who was very instrumental in organizing this exchange visit. The exchange visit has helped the community health workers of the two countries to have detailed discussion on their issues through this platform. In the four-day session, the participants not only discussed their challenges, shared successes but also set ambitious targets for the future. He said the governments in the two countries are not worker-friendly and don’t make policies that benefit workers. He advised the workers of the two countries not to lose hope as success comes through hard work and dedication. The little successes they have achieved so far in Pakistan and Nepal are the result of their consistent struggle. The high targets these workers have set here can only be achieved through collective efforts. He said it’s heartening to see sisters becoming so vocal about their issues that we men hardly get a chance to speak, which is a significant achievement. The technical support from WERO will always be with them. Nepali sisters should be hopeful that with the technical support from Jeni, Aisha, and WERO, their issues will be resolved soon.

Another lesson is that when people from different religions, countries, and races come together and accept each other wholeheartedly, difficulties get resolved, and people take along a positive message for the rest of the world.

Recommendations

During the meeting many recommendations were given by representatives of all trade unions. The common as well as specific recommendations are listed below:

1. Job Security: Ensure no illegal eviction, removal, or retrenchment of employees, including private sector.

2. Strict enforcement of workplace and online harassment laws.

3. Provide micro-financing to Laid-Off Female Journalists to start businesses.

4. Adopt and enforce gender-sensitive policies in all organizations.

5. Appoint female judges in redressal platforms like labor courts, National Industrial Relations Commission (NIRC), Implementation Tribunal for Newspaper Employees (ITNE).

6. Tailored training facilities for female leaders in media organizations.

7. Implement strict female quotas in CBAs and other unions, especially in leadership roles.

8. Adopt and enforce safety protocols in workplaces.

9. Establish counseling centers in media organizations for harassment survivors.

10. Ensure transparent advertisement payments to media organizations, and link it to employee salary payments.

11. Foster unity among all trade unions to jointly fight for workers' rights.

12. Strengthening Women’s Department and organsiations by ensuring full staff and support.

13. Raise awareness about the importance of forming unions.

14. Ensure 33% female participation in trade unions and CBAs, including leadership roles. In Sindh Government CBAs too, women should be brought in leadership position.

15. Strengthen Sindh Commission on the Status of Women (SCSW) to raise voice for women's issues in Sindh, offer training, and observe Rural Women's Day on October 16th.

16. Form anti-harassment committees in every organization and empower the Commission to take action on non-implementation of anti-workplace harassment laws.

17. Align laws on bonded labor and child marriage with the standard age of 18 for girls; Advocate for women's participation in unions to address these disparities.

18. Prioritize the implementation of ILO Conventions 190 and 111 to eliminate violence, harassment, and discrimination at workplace.

19. Develop a Comprehensive Fishing Policy that prioritizes the role of women and includes them in decision-making processes.

20. Provide basic facilities like clean water, health coverage and safety at workplace for fisherwomen; create alternative employment options at district level for women dependent on fishing.

21. Devise a Climate Change Policy to address rising sea levels and mangrove destruction, crucial for the fishing sector.

22. Restore natural river flows and revitalize delta areas to support rehabilitation efforts.  Ensuring these changes will provide women with dignified work conditions, economic stability, and a voice in shaping policies that affect their lives

23. Ensure equal wages for equal work and facilities for women across all sectors.

24. Implement laws to guarantee 5% representation of women in trade union management committees.

25. Ensure working-class representation in parliament with fair allocation of seats, free from gender discrimination.

26. Enact and enforce laws to protect domestic workers.

27. Ensure contract labor, especially women on long-term contracts, are included in EOBI coverage

28. Ensure private sector compliance with social security provisions like EOBI, SESSI, and Workers Welfare Board.

29. Advocate for the rights and protections of women in the textile sector.

Conclusion

The 4-day session with Nepali and Pakistani Lady Health Workers has highlighted many important points. Like other countries, trade union movement are declining. The visionary leadership once we saw in the late '80s is missing now. Privatization and contract jobs have weakened these unions as employees are barred from joining unions, which is their basic guaranteed under the constitution of Pakistan. So first and foremost, creating awareness on the right to association is mandatory. Mobilizing women in trade unions is crucial for their success, as evidenced by successful movements worldwide where women took leadership roles. In Pakistan, the absence of female participation has historically weakened trade unions. However, the involvement of women in unions like LHWs and the Fisherfolk Forum has shown significant success.

The women-led unions not only resolve workplace issues but also champion broader community concerns, which are often overlooked by male-dominated unions. However, workplaces with male majorities often discourage female participation in unions.

While trade unions in Pakistan face numerous challenges but women's inclusion is essential for their effectiveness and success. Continuous education and advocacy are necessary to overcome these challenges and change of mindsets within the unions and society at large is mandatory. There is dire need to maintain unity.

Way forward

• Organize a national conference under the banner of WERO in Karachi or Quetta so that representatives from all provinces come together to formulate service structure and prepare a charter of demands, which should be developed with the collective input from LHWs from around Pakistan. But it should be done after the general election in the country.  

• The LHWs will continue their struggle in an organized manner without succumbing to any pressure and will keep their unity intact and respect the constitution of Pakistan.

• Traditionally, trade unions have focused solely on workplace issues, neglecting community concerns. It's imperative for unions to broaden their scope and advocate for community issues alongside workplace ones. For this they should join hands with trade unions like Fisherfolk forum which address community issues.

• Engaging with the community is also essential since health issues disproportionately affect women and children, who constitute significant majority. If we mobilize this powerful demographic to support our demands, there is a better chance of resolving these issues.

• Expand international networking with organizations like PSI, WHO, ILO and UN to raise issues and seek support at international level.

• Getting service structure is one point agenda for LHWs

• Such exchange visits should be arranged in the future as well with other countries to have common learning and sharing.

• Senior trade unionists should be involved in training future leaders and members.