Daring to re-engineer the health system

The Ministry of Health is set to implement new innovations to turn around the sector

By Tsitsi Matope

MASERU — It is almost 14 years after the 189 countries that are members of the Unit­ed Nations committed to achieving the eight International Millennium Development Goals (MDGs) following the Millennium Summit of the UN in 2000.

Although there were 189 countries then, the number has since risen to 193. During the same summit, at least 23 international organ­isations also committed to helping countries achieve the goals from 2000 to 2015. The out­come of that commitment will be unveiled next year.
However, for many African countries, en­suring continued efforts to revitalise strate­gies that improve the health of their nations was a major priority area.

The common sense behind prioritising health development was that measures would gradually impact positively on other targeted areas such as eradicating extreme poverty, the attainment of universal primary education and ensuring environmental sustainability.

In many cases, a largely unhealthy society struggles to create a sustainably vibrant econ­omy. The workforce in all sectors is negatively affected and this is evident in the case of Af­rica and particularly in the ailing agriculture sector.

On the other hand, sickly children are un­able to attend school, making it difficult to break the cycle of poverty.

For developing countries like Lesotho, there could not have been any other serious business compared to investing in health.

It has been a decade-plus of hard pushing of various health programmes to ensure signifi­cant improvements in the health system.
Despite such efforts, Lesotho has a high ma­ternal and child mortality and also a high HIV prevalence rate.

The 2009 Demographic and Health Survey speaks of a country that has battled to signif­icantly bring down infant and maternal mor­tality but managed to stabilise the HIV prev­alence rate, which stands at 23 percent, the third highest in the world.

Statistics show that every year, 91 infants per 1000 live births die, 117 out of 1 000 chil­dren below the age of five also die and shock­ingly — 1 155 mothers out of 100 000 also die during delivery and six weeks after delivery.

Despite what the figures say, in an inter­view this week, the Director General in the Ministry of Health, Dr Piet McPherson said his Ministry will not stop to push for the strengthening of health systems countrywide.

He emphasised the need for a paradigm shift in health that would see all stakeholders understand that health is not the responsibili­ty of his ministry alone.
LT (Lesotho Times): 2015 is just around the corner; do you think you are likely to meet the health-related MDGs?

PM (Dr Piet Mcpherson): The health sector, development partners and indeed the government have worked hard since 2000 to strengthen the health delivery system in line with the MDGs’ expectations and also our na­tional health policies. The challenge is that we have been relying on data from the De­mographic and Health Survey, which is done every five years and in some ways, we feel that it does not really inform us or measure the out­put of the efforts in the last 13 years.

I am optimistic that we have done well in some areas but the question is how to effec­tively measure our achievements using more reliable tools. On the other hand, there are also other factors that we should look at, that might have also compromised our efforts. We have to collectively deal with them.

LT: What are the other factors that could have negatively impacted on your efforts?
PM: Well, there are many social, geograph­ical and economic factors that can negatively impact on the delivery of health of any na­tion and all I am saying is, we need to work together to achieve what we want. Health is a human right and approach to delivering ser­vices requires a fundamental paradigm shift. We need to move away from a premise that believes the responsibility to ensure a healthy nation lies in the Ministry of Health and part­ners alone.

LT: Any examples of such factors that might have affected delivery of service?
PM: For example, communities can’t access health facilities if there are no roads. Pregnant mothers will not deliver in facilities if there is no water and electricity, to mention but a few. This is why we are promoting a multi-sectoral approach and collaboration by different stake­holders.
LT: So with 2015 around the corner, how are you going to measure the impact of your programmes since 2000?

PM: Knowing the accurate impact of pro­grammes is of utmost importance. As I am speaking, we are undertaking a training ex­ercise that would see the leadership in all dis­tricts work with health personnel to conduct a comprehensive assessment that would meas­ure the strengths, weaknesses, opportunities and threats of the health services in their re­spective districts.
It is only when we have a clear understand­ing of what is happening — why it is happen­ing, what is not happening and why it is not happening, that as a nation, and indeed as a sector, we can be in a position to say what we achieved and where we are going.
This is very important because we cannot expect other stakeholders to play a significant role in the development of the health sector if they do not understand why the health system is working or not working.

Their participation and ownership of the system and its programmes would be severe­ly undermined. The Honourable Minister of Health has called on us (the technical people) to ensure that we put in place systems and structures that will enable effective participa­tion and ownership of the health system and its programmes by all community leaders. Who are these community leaders?

PM: District Administrators, members of parliament, chiefs and principal chiefs, coun­cillors, church leaders, civil society, the me­dia and many others. We are doing this, like what the Minister of Health said: “To open up the health systems and focus on prevention”, and this can only happen if our programmes are owned and driven by various leadership and community structures.

LT: So does this mean all stakeholders are now accountable for the state of health in Le­sotho?
PM: Yes that’s what we are saying — we are partners and should all participate in the development of the health sector and be accountable. My point really is that, with or without 2015, the health of this nation should be a priority and our concern as a nation. Im­provement of health systems is the responsi­bility of all leaders in various sectors. They should take the responsibility to demand quality services and play their role to also help improve service delivery.
We are all responsible to correct this histori­cal wrong which says health issues are for the Ministry of Health and its partners alone. Yes we lead, guide, facilitate dialogue and inter­pret policies but ideally, it’s more progressive to involve all stakeholders.

LT: Let’s talk about the intended health im­pact assessment. How else and in which areas is this going to help improve service delivery?

PM: We are going to carry out this dis­trict-owned and led comprehensive assess­ment because we need to ensure that our re­sources target the weak areas. We also want the full participation and understanding of all health professionals and local community structures. The health system can only be ef­fective if it is designed to operate proactively and also when its objectives are well under­stood by all stakeholders.

LT: So is it a fact that over the years the system was more or less reactionary?
PM: Very reactionary in its approach, yes — but let me also say the current leadership’s drive is for the sector to take a proactive ap­proach.

LT: What are you mainly focusing on?

PM: Our efforts are focused on strengthen­ing the prevention arm of the health services. Pro-activeness will help us curb the disease burden by ensuring that a greater percentage of our nation does not get sick and that treat­ment becomes a secondary strategy in our health system.
LT: What should we then expect from the health assessment?

PM: Well, considering the work we have done over the years, I have no doubt that there were some improvements in some areas; take for example, the HIV prevalence rate, which has stabilised at 23 percent. It’s because of various activities pro­moting HIV testing and treat­ment and changing people’s be­haviour that the epidemic has stabilised.

LT: What about the high new HIV infections. Are you expecting a decline from 19 000 per year?

PM: Yes and No. You see, there is need to understand the need for all stakehold­ers to push for a reduction in new HIV infec­tions. It is one of our biggest worries. While we say we should all work towards strength­ening prevention, the issue of HIV prevention speaks directly to every individual and it is only when, as individuals, we become honest and faithful to ourselves that we can see a sig­nificant reduction in new infections.

LT: Let’s talk about the high death rate of mothers during delivery and soon after they give birth and also about child mortality, do you think you have done enough to drastically reduce the numbers?

PM: We continue working towards ensur­ing pregnant mothers access health services, through our health centres and outreach pro­grammes. Currently, we have systems in place and it’s a matter of ensuring they effectively work to help reduce deaths of mothers and children.

In the case of pregnant mothers, the strat­egy is to make sure they are attended to on time while those living with HIV are on early treatment. We have to continue working out new innovations that can apply in different lo­cations to ensure all mothers deliver at health centres.

The strategies we apply in urban Maseru are different from those in Thaba Tseka, for example. However, because some mothers die soon after giving birth, we also need to ensure we continue strengthening our follow-up sys­tems, especially in the hard-to-reach areas.