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PRIMARY HEALTH
CARE PROGRAMMES
Implementation
of the Primary Health Care (PHC) strategy in 1979 implied a
major change in the way the health delivery system of Lesotho
was organized. PHC represented a shift from centralized service
delivery to a more decentralized approach that promotes and
depends on extensive community involvement and participation.
Implementation of PHC necessitated redefinition of boundaries so
that the Health Service Area (HSA) concept was conceived; review
of the nursing cadre to empower nurse at the Health Centre level
so that they are able to provide a more comprehensive package of
services; inception of the community health worker cadre which
comprise of volunteer workers at the community level who are
trained to provide basic preventive, curative and rehabilitative
services. The principles guiding PHC implementation derive from
the recognition of communities as vital players in the delivery
and maintenance of good health among members, hence one of the
key activities associated with PHC is extensive and aggressive
health promotion and education to facilitate adoption of
lifestyles and behaviour changes that are conducive to good
health.
Primary health care is essentially a public health strategy that
aims to prevent and contain the spread of communicable and none
communicable diseases through immunisations, health education,
disease surveillance, community sensitisation forums and
provision of curative and rehabilitative services. The referral
system is designed such that PHC is the cornerstone and most
cost effective aspect of service delivery.
Ideally management, planning and budgeting for PHC activities
should take place at the local level, so that objectives ad
targets are identified at the community level and are therefore
responsive to actual health & social welfare conditions at his
level. However, for a number of reasons, including lack of
capacity at the HSA level, particularly in the area of financial
management and accountability systems as well as inadequate
staff and skills, planning, budgeting and coordination of PHC
activities have tended to be centralised and led by the vertical
programmes. The system of vertical programmes has the advantage
of easing administration because all donor funds are channelled
through vertical programmes. On the other hand this system has
the disadvantage of limiting the potential gains of community
participation and involvement in the planning & implementation
of PHC and limiting access to budgeted funds by the
implementation/ HSA level.
The
role of Primary health care programmes is to coordinate planning
and budgeting functions for primary health care, ensuring that
HSA plans are in line with priorities and principles of PHC.
Other functions include monitoring implementation and trouble
shooting, developing policies and guidelines and facilitating
training of health workers on use of these tools, setting
standards and developing curricular for training of community
health workers, providing technical support and supervision of
the HSA level, development of health education materials and
evaluating the impact of programmes at the community level. All
activities and decisions at this level are undertaken in
consultation with the HSA level. Currently there are six
vertical programmes under the PHC department.
DOCUMENTS….
-
District Health Package Document
-
Strategic Framework for Decentralisation
MOHSW
Contact person
Dr D Lugemba
Position :
Director
Telephone:
+266- 22325314
Fax:
nil
Email:
nil
Disease Control
The
mandate of the Disease Programme is to develop and implement
systems for the control of key public health conditions. At
inception the main foci of the programme was tuberculosis,
sexually transmitted diseases (STD’s) and leprosy, overtime the
programme has expanded to accommodate the scourge of
non-communicable diseases, particularly diabetes, cancer and
hypertension and the HIV/AIDS pandemic. Eventually the AIDS
programme was delinked from disease control and is now a
Directorate, which incorporates STD’s. At present the Disease
Control coordinates the implementation tuberculosis and
non-communicable disease programmes in the country and leads the
processes of responding to disease outbreaks in the different
parts of the country. The objectives of the programme are to
reduce mortality, morbidity and disability caused by
communicable and non-communicable diseases through effective
coordination and management of preventive, promotive and
rehabilitative services.
Tuberculosis
control remains the biggest challenge facing not Disease Control
but the entire Ministry and the country as a whole. In the past
two years efforts have been made, through global fund support to
strengthen the response to TB, but progress has been highly
limited especially because the TB sub programme has had no full
time manager for some months. Some achievements have been
accomplished in the form of review of the TB policy, treatment
guidelines and development of a TB Strategic plan. Over and
above development of guidelines and policies, the programme also
coordinates training of and supervises the district based health
workers as well as the community health workers on the direct
observation treatment (DOTS). The programme manager also has
the responsibility for identifying capacity gaps and developing
strategies for minimising these gaps; coordinating TB
surveillance as well as monitoring and evaluation of programme
implementation at the district level; resource mobilisation.
Prevalence and control of tuberculosis has been adversely
affected by the HIV/AIDS pandemic with approximately 70% of TB
patients affected by the virus. One of the challenges faced by
the Ministry is the need to effectively integrate initiatives of
this programme with those of the National AIDS Programme and
those of the National AIDS Secretariat, in order to optimise
benefits accrued towards TB control.
Control of non-communicable
diseases is another important function of Disease
control. Given the impact of lifestyle on the prevalence and
incidence of non-communicable diseases, the programme focus has
been on the design and development of suitable information,
education and communication materials to encourage people to
adopt healthy habits to prevent these illnesses. The programme
has undertaken assessment of prevalence as part improving
programme management and planning. The role of the programme is
to develop and disseminate policies and guidelines, in
consultation with the implementing level. Coordination of
capacity building initiatives for effective implementation of
treatment guidelines is coordinated by the programme. This
level also undertakes supervision of HSA's. The programme also
facilitates cross pollination of good practices between the
HSA's, for example formation of support groups for diabetics and
hypertensive patients.
DOCUMENTS….
Contact person
Dr
Maama
Position
Head, Disease Control
Telephone
+266 - 22325314
Fax
+266 - 22322445
Email:
letsiem@health.gov.ls
Family Health Division
Family Health has often been cited at the core business of the
Ministry of Health & Social Welfare, possibly because services
coordinated under Family Health range from those for infants to
those for adults, especially women. The mandate of this
programme is to coordinate and supervise implementation of
family health services in the country and to mobilise resources
for implementation of priority services. The goal is to reduce
infant, child and maternal mortality and morbidity rates. Sub-
programmes under Family health are:-
Reproductive Health
The
aim of the reproductive health programme is to facilitate
provision of effective reproductive health services. The
mandate of this sub-programme is driven by recognition and
appreciation of the rights of men and women to access
information on family planning and provision of these services
so that they can make informed choices. The mandate goes
further to facilitate delivery of safe and affordable services
to protect pregnant women and ensure safe delivery of babies
through various guidelines around safe motherhood practices and
emergency obstetric care including prevention of mother to child
transmission of HIV/AIDS. With the advent of HIV/AIDS,
empowerment of adolescents and youth on knowledge and skills
relating to their reproductive health choices and strengthening
clinical management of sexual and child abuse have become
prominent features of the Reproductive health sub-programme.
Child survival
The
child survival sub-programme is the cornerstone for prevention
and care of infant and under-five diseases. Like maternal
health, child survival is an important indicator of the
socio-economic status of any society and the importance of
initiatives towards reducing maternal and infant mortality rates
cannot be understated. Two key pillars of this sub-programme
are the expanded programme on immunisation (EPI) and the
integrated management of childhood illnesses (IMCI). Of late,
for obvious reasons attempts have been made to integrate
paediatric AIDS care into the standard IMCI guidelines. The aim
of the EPI is to control and prevent vaccine preventable
diseases such as measles, polio, myelitis, tuberculosis,
whooping cough, tetanus, diphtheria and hepatitis B, while IMCI
focuses on case management of non-preventable diseases such as
diarrhoea, acute respiratory infection, HIV/AIDS as well as
malnutrition. Over and above the standard function of PHC
programmes, child survival initiative include developing
capacity of community health workers and parents for correct
home and health seeking behaviour for common childhood illnesses
through training and production of guidelines and health
education materials.
Nutrition
The
key mandate of the Nutrition sub-programme is to improve the
nutritional status of the population and to promote healthy
growth and development of children. Objectives of the
sub-programme are mainly to reduce under-five malnutrition,
reduce micro-nutrient deficiency disorders and to promote
healthy living and diet. The programme has become increasingly
active in advocacy and education for promoting suitable
nutritional practices for people living with AIDS as well as
infants born to HIV positive mothers. Specific sub-programme
functions include coordination, production and dissemination of
information, education and communication materials as well as
distribution of nutritional and therapeutic supplements, breast
feeding promotion, development of guidelines for the management
of malnutrition
Community based Health
Objectives of this sub-programme are to strengthen health care
services at the community level, to ensure that services at this
level are safe and of good quality, to facilitate training of
community health workers, to maintain a database of active
community health workers, to provide overall coordination and
management of community based services, including home based
care. Originally the community health worker cadre was purely
voluntary but as the volume of work and expectation have
increased overtime the Ministry has had to consider
implementation of sustainable incentive systems that will ensure
continuity and commitment of this very important group of health
providers. This is just one of the challenges facing this
sub-programme, the other major one is insufficient budget
allocations which often lead to stock outs on essential supplied
used by community health worker kits, at times the programme
goes for months without replenishing community health worker
kits, thus deeming them redundant.
DOCUMENTS….
-
Family Health Annual Report, 2004
-
Reproductive Health Policy
-
Adolescent Health Policy
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EPI Policy
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EPI Financial Sustainability , 2004
Contact person
M Mohai
Position
Head, Family Health
Telephone
+266 - 223323538
Fax
nil
Email:
majarabp@familyhealth.gov.ls
National AIDS Prevention & Control Programme
The
key objective of the AIDS programme is to coordinate
strengthening of the national response to the HIV/AIDS pandemic,
especially to strengthen the capacity of the Ministry of Health
& Social Welfare so that it provides leadership in the fight
against the pandemic. The framework guiding the mandate of this
programme comprises of prevention and health promotion, care and
treatment, health standards and systems and evidence based
policy and strategy formulation. The Programme is structured
into four units:- Counselling and community based programme of
which the focus is to provide supportive counselling, care of
carers programme, VCT and care of orphans and vulnerable
children. The second unit, Behaviour Change and Communication
focuses on social mobilisation and advocacy. Clinical care
services unit provides leadership and coordinates management of
opportunistic infections, TB/HIV and STI/HIV coordination, PMTCT
and palliative care. The research and surveillance unit manages
information and reports on HIV/AIDS prevalence and trends and
undertakes evaluations.
The
AIDS programme coordinates activities not only within the
Ministry but also nationally in collaboration with the National
AIDS Secretariat and local councils at the district level. Some
of the key products of this programme include development of
home based care, HIV clinical management, PMTCT and VCT
guidelines, which were developed in collaboration with all
stakeholders including the CHAL and the private sector.
Currently the key areas of coordination include strengthening
VCT, PMTCT, Paediatric AIDS and ART services at all the
different levels of the health system. Strengthening is
undertaken through activities such as providing policy and
technical guidance and supervision for implementers;
facilitating training and sensitisation of different cadres of
health workers (laboratory, pharmacy, nurses, counsellors etc)
on good practices, ensuring adequate supply and storage of
drugs; resource mobilisation as well as monitoring and
evaluation. The main challenges include inadequate staff
numbers and skills and infrastructure (physical space) to cover
the needs as identified around the country and to strengthen the
partnership with traditional healers.
DOCUMENTS….
Contact person
Ms
M. Boikanyo
Position
Director
Telephone
+266 - 22328005
Fax
nil
Email:
mailel@health.aids.directorate.gov.ls
Health Education
Functions of the Health education programme include the
development and implementation of policies and a national
strategic plan for the sector as well as to develop and
disseminate specialized and targeted information and educative
materials in collaboration with all stakeholders including
communities. The programme also coordinates training of
community health workers and other cadres in the education and
promotion of good health and social welfare practices,
undertakes research on the target audience, media and impact of
IEC materials. An important function of the programme is to
provide technical and material support on educative and
promotive activities at the HSA level. The Health education
division has become increasingly active in the area of
anti-smoking initiatives around the country.
Contact person
T Ntoampe
Position
Chief Health Educator
Telephone
+266 - 22325686
Fax
nil
Email:
nil
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