Health sector: the case for reform

Health sector: the case for reform

Staff Reporter


WEAK partner alignment and internal coordination mechanisms within the Ministry of Health have led to challenges in translationg health development plans into action, thepost heard last week.

The revelation was made at the Lesotho-United Nations High-Level roundtable discussion held last Thursday.

The theme of the discussion was Transformation and Reform – the path to Lesotho’s sustainable development.

Experts who spoke at the discussion said Lesotho has not had a comprehensive health strategic plan to guide medium-term agenda for the health sector for the past 10 years.

This has resulted in uncoordinated health interventions among stakeholders.

The health sector discussion was led by Health Minister Dr ’Molotsi Monyamane.

It was also revealed that although there is a committed leadership at national level, there are still challenges in coordinating internal mechanisms to attain developmental goals.

The discussion showed that there are 305 primary health facilities, 22 secondary level facilities comprising 22 hospitals with at least one hospital in each district and two major hospitals.

It was also shown that more than half of the health facilities in Lesotho are owned by the government while the Christian Health Association of Lesotho (CHAL) owns 38 percent with the remaining facilities being owned either privately or operated by non-governmental organisations.

Seventy-five percent of the health sector staff is from the Ministry of Health while 22 percent is from CHAL and 3 percent from NGOs.

It was also highlighted that “community-based health service delivery such as outreach services are not routinely planned for and delivered” despite that there is the National Health Policy with objectives and measures for addressing community-based health services.

The need to engage with the community to ensure community-led, people-centered health services delivery was also stressed.

It was revealed that “80 percent of the population can access a health facility within two hours of walking but due to the challenging terrain this travel is quite difficult, especially for critically ill patients”.

The discussion also showed that “the decline in mortality is not commensurate with the improved access suggesting that poor quality of health services may be an issue and requires systematic investigation”.

It was also said anectodal evidence and assessments show that adherence to standards of care with health facilities and mechanisms for instituting the standards are not fully functional.

It was recommended that Lesotho should consider looking at issues that can be speedily undertaken in a cost-effective manner so that they can be embarked upon.

It was also suggested that the country should consider introducing advanced midwifery training in the schools of nursing so as to address high maternal deaths that occur in health facilities.

The discussants urged the government to consider looking into the aspects of ethics of health care providers and the engagement of relevant professional bodies to play their part in terms of ensuring adherence to standards and implementing disciplinary measures.

Another suggestion was that the ministry should set up a mechanism to facilitate the implementation of recommendations made in reports shared or produced in the country and for making the health sector accountable for services rendered to the nation.

Anther challenge that was brought to the fore was the health care financing.

It was highlighted that the financing is mainly from tax revenue, loans and grants from foreign governments, development partners, as well as direct out of pocket payments, and insurance premium payments by individuals and private companies.

In 2013 the total health expenditure was US$235 per person (approximately M4 285) out of which about M3 391 was the government’s expenditure per person.

“This proportion is often used as a measure of the extent to which a population is prone to/or protected from catastrophic health spending and impoverishment,” a document that was the basis of the discussion reads.

It says when the proportion is less than 20 percent, the population is said to be relatively well protected from catastrophic health spending, as well as being shielded from financial ruin.

The document says “inefficient allocation of the available health resources has been observed”.

It says primary health care expenditure accounts for only 9 percent of the ministry’s budget compared to 51 percent expenditure for secondary and tertiary care, while the national level consumed 40 percent of the budget.

“Whereas the country’s policy favours primary health care, allocation of resources is disproportionately in favour of secondary and tertiary care,” it reads.

The discussion also highlighted that Lesotho’s M779 per person expenditure on health is higher than the M490 per person recommended by the World Health Organisation and highest in the region.

It was stressed that chronic underspending of health resources and inefficient fund allocation is also a challenge.

“Despite plans to undertake and institutionalise national health accounts for the past ten years, this exercise has never been undertaken,” the document reads.

About the health workforce, it was shown that it is inequitably distributed with less than 20 percent of human resources for health at primary care level providing 60 percent of the health care of the country.

Village health workersIt was also shown that according to the Nursing Education Partnership Initiative 2011, Lesotho has only about 26 percent of the WHO recommended workforce needed to attain the Millennium Development Goals.

“Paradoxically, there is a large proportion of unemployed health graduates in Lesotho showing a mismach in human resources for health planning that links needs, production and utilisation to viable established posts,” the document reads.

It says there is a need to establish a functional human resource information system to facilitate informed recruitment and deployment, including coordination and close working relationship between the ministry and the Public Service Commission.

Lesotho’s health sector

Graphic illustrate story: Timeline illustration

No of Primary Health Facilities     No of Sec Level Facilities    Hospitals Per District

305                                                                                  22                                                        1

  • Half of All Hospitals Are Owned By the Government; 38 percent owned by Christian Health Association, Remaining owned either by private operators or NGOs
  • 2013: Health expenditure per person was US$235 per person (approximately M4 285) out of which about M3 391 was the government’s expenditure per person.

Molotsi Monyamane, right, and Julitta Onabanjo  the UNFPA East and Southern Africa Region Director)

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