The Lady Health Workers (LHW) Programme, instituted in 1994, is considered one of the largest and successful community based primary healthcare initiatives in the world. The lady health workers’ role has received recognition by the global health bodies in improving Pakistan’s maternal and child health indicators. Currently more than 130,000 lady health workers reach out to 60 to 70 per cent of the country’s population residing in rural and low-income urban areas.

Perhaps if it was not a collective struggle for their rights, the lady health workers would have continued to suffer injustice in silence: a low wage, no benefits and insecure job. It was death of a health worker at child birth that compelled Bushra Arain, a Lady Health Supervisor, to rebel against the irony: health providers’ own deprivation of health facilities and lack of decent work conditions. She and several other lady health supervisors mobilised the workers and founded the union, the All Pakistan Lady Health Workers’ Welfare Association, in December 2008. By early 2009, each district had a Baji (elder sister), a dynamic activist health worker to prepare the cadre for struggle. The union took to legal intervention and street power to claim their due rights at work place. The phenomenon was unique: never before in Pakistan’s history had women workers exercised the right to ‘collective bargaining’ in any sector, much less in the low-paid care economy.

 The case study aims to document the LHWs’ struggle, review the constraints they faced as women workers in a public sector health programme and as caregivers, identify the union’s strategies and highlight the achievements of their eight-year long battle.

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