Health system ailing

IN the past 10 years, the government of Lesotho has made the right moves in terms of improvement of health systems.

These include, the free provision of primary health in public clinics; building additional primary health care centres and improving the types and kinds of services provided; recruiting health workers from other countries to increase the numbers; facilitating testing for HIV through the Know Your Status campaign; expanded PMTCT programmes; and improvement of family planning services in public health centres.

The number of professional health care workers in Lesotho has been severely affected by a loss of health care workers to other countries, as a result most of the medical doctors in private practice also work in government hospitals and a number of nurses working for government hospitals also run private clinics.

While this flow of health workers between public and private health services has meant the country has been able to maintain service provision, it has been detrimental to public health services in other ways that will be discussed later.

In terms of the Millennium Development Goals, there are four goals directly related to health and social welfare that can be used to measure how well or how badly the Ministry of Health and Social Welfare is doing.

Reports from Unicef indicate that Lesotho is not likely to meet the MD goals in any of the four.

The first MDG in terms of Lesotho’s priorities is to combat HIV and Aids, TB and other diseases. While there has been global recognition of efforts in this area indicators are that the country has only managed to halt the spread of HIV.

This is good news in itself, but it is desirable to achieve better results where we can, especially on TB.

The second goal is to halve extreme poverty and hunger and indicators show that most children under five are significantly affected by hunger with increases in the incidents of stunting; the fifth and sixth goals are about reducing child mortality by three quarters and maternal mortality by two thirds and Lesotho is not likely to achieve these two goals either.

The most pressing issue for health care service provision in Lesotho right now is the quality of health services.

The health sector in Lesotho, as in most countries with high HIV and TB burdens is barely coping with service demand.

In addition, public health services are in distress for a number of reasons associated with poor oversight and controls within the Ministry of Health and Social Welfare, including a persistent lack of drugs at public health care centres.

This problem is directly attributable to the flow of health professionals between public and private health care, where drugs meant for provision in the public health sector have been sold to patients using private health care services.

The quality of health care service provision in the public sector is very poor. This can partly be attributed to over-worked health care workers, but the other improvements in the health care sector should have taken care of part of the problem, so it can only be assumed it is a problem of poor attitude to patients.

There has been late transfer of funds from the national Ministry of Health and Social Welfare to the districts.

In some cases there have been reports of transfers being made within days of the end of the financial year. As health care services have come under increasing stress, the solution at most centres has been to have a daily quota of patients to be attended.

The number is not decided on the basis of persons in most need of help, but rather on a first-come first-served basis. This approach clearly works against the elderly, children and the very sick.

For years now, there has not been adequate provision of ambulance services. The main problem with provision and implementation of adequate ambulance services in Lesotho is tied to the lack of street names, clearly identified roads and house numbers.

This is a critical problem since ambulance services are key to emergency medical services.

In terms of child and maternal health, the indicators, based on how Lesotho is doing in achieving the goals set in the MDGs, show that while the Ministry of Health and Social Welfare has done well in terms of improving health services and giving access to more citizens, the impact on women and children’s health has been rather limited.

The Minister of Health and Social Welfare recognised at one World Aids Day celebration that HIV has had a negative impact on Lesotho’s health indicators.

Clearly, child and maternal health has borne most of the impact, but we should be beginning to see the impact of PMTCT programmes, increased testing and the provision of anti-retroviral drugs to a larger percentage of people living with HIV and Aids.

Some of the areas where the Ministry of Health and Social Welfare can make improvements with the biggest impact, even on child and maternal health, are those related to improvements in the quality of health services.

The paper has not dealt directly with issues of social policy and I have pointed out weaknesses in the health sector without making any proposals for dealing with the problems.

The next article, which will be a continuation of what we discussed, will deal with the social policy issues related to child and maternal health and recommendations for improving the quality of service provision in the health sector.

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