A comprehensive infrastructure rehabilitation programme has been compiled, and an ongoing reform process is aimed at ensuring an effective, efficient, affordable, and sustainable delivery system for health services. Lesotho’s national health plan of 1995 – 2000 identifies several key components or policy and institutional reform:
- Financial reform
- Human resources reform
- Decentralization of services
- A district health package bringing services to all Basotho
- Improved coordination of donor efforts
Institutional strengthening is to be focused on human resource and organizational development as well as financial management and budgetary planning. Infrastructure operations and maintenance are also to be strengthened in support of decentralized implementation, while the cost-effectiveness of elements of the district health delivery systems is to be improved.
The first phase of the government’s development objectives, scheduled to be implemented in 1999, consisted of the following key objectives:
- Ensuring effective and efficient mobilization of local resources, while facilitating rational and more equitable allocation of health expenditure in a decentralized system.
- Effecting improved and timely delivery of quality health services at district and community levels.
- Improving the distribution of health facilities and ensuring their maintenance, with access to such facilities also to be strengthened.
- Ensuring that high quality, effective and safe pharmaceutical supplies are available to all Basotho.
Budget allocations for the requirements of the Ministry of Health are aimed at the promotion of public health, while legislation and regulations maintain the country’s standards of health provision. Public and occupational services include the active promotion of sanitation and universal access to a protected source of water.
Health Services Management
A network of hospitals, clinics and health centers provide basic facilities throughout most of the country. The Ministry of Health and Social Welfare, in conjunction with various non- governmental and private agencies, as well as donors, maintains a comprehensive, coordinated and integrated health system. The technical aspects of health services cover research and laboratory work, the maintenance of professional standards, disease control, environmental health and health education. The Department of Pharmaceutical Services is responsible for the provision of drugs to all hospitals and health centers, while the National Drug Services Organization is responsible for the procurement and distribution of drugs throughout the health system. A parastatal corporation handles manufacturing and testing.
In the aggressive development of this sector, participatory planning ensures that health needs are met by implementing community based health interventions and rehabilitation programmes. The key institutions for the delivery of health care services in Lesotho are Health Service Areas (HSA). The country is divided into a number of such health service areas, each based on a government or mission hospital. The central hospital in each HSA services covers a number of village health centers with resident nurses or nurse practitioners, as well as clinics, which receive regular visits from doctors or nurses. It also trains community health workers from individual villages, thus extending health care throughout the whole service area.
The World Health Organization, a specialized UN agency, plays a key role in directing, coordinating, and supporting a wide spectrum of health-related activities in Lesotho.
These include the strengthening of health planning and management, development of human resources, programmes such as AIDS control, mental health, school sanitation, disaster preparedness, community participation and family health, including safe motherhood. Numerous other agencies and international organizations have supplied assistant and made funding contributions, while private and public organizations are also largely responsible for health services in Lesotho. In particular, nine of the 18 HSA hospitals are owned and run by churches linked through the Christian Association of Lesotho.
Embracing curative, preventive and rehabilitative services, Lesotho’s health system consists basically of the following levels:
- A village network of over 5000 volunteer community health workers.
- Clinics/health centers, where teams serve from 6000 to 10 000 people.
- Health Service Areas, with teams operating from referral hospitals.
Apart from the village health workers, various other categories of community based health workers include traditional birth attendants, distribution agents and water minders. This broad-based support for the health sector has been instrumental over the past decade in the decline of certain diseases such as polio and the success of certain programmes. Health centers or local clinics are responsible for immunization of children, ante and post natal services, family planning consultations and basic curative services. With the shortage of nurse clinicians, it is hoped that in time sufficient numbers of health assistants will reinforce health work at field level. Health centers are staffed by clinicians that are able to diagnose and prescribe or by nurses or nursing assistants. Construction of filter clinics in Maseru has been ongoing to relieve pressure on the outpatient department of the national referral center, Queen Elizabeth 11 Hospital.
District hospitals are expected to staff all facilities with appropriately qualified staff and the equipment needed to deliver health services. Three district hospitals (in Mokhotlong, Berea and Qacha’s Nek) have been rehabilitated and upgraded. There are several general hospitals in Lesotho, as well as two specialist hospitals and a privately run military hospital.
Maseru Private Hospital at Thetsane was established at the end of 1996. An up market, modern facility with excellent staff, the hospital provides quality medical, nursing and personal care. It boasts a well-equipped maternity unit, and a 24-hour casualty and emergency unit. Many additional services are available. Local medical specialists as well as visiting specialists from Bloemfontein in South Africa consult and operate on a regular basis.
|Position:||Minister of Health|
|Address:||P.O Box 514, Maseru 100|