The health system
in Lesotho can be divided into four tiers. At the primary
level Health Posts which provide basic services and operate
at regular intervals rather than daily, then Health Centres
which provide basic preventive, promotive, curative and
rehabilitative services. The primary level is followed by
the secondary level which comprises of 16 District Hospitals
which provide services similar to health centres, though at
this level services are more comprehensive. The tertiary
level comprises of Queen Elizabeth II Hospital, Mohlomi
Mental Hospital, Bots`abelo Leprosy Hospital and Senakatana
AIDS Clinic. These Hospitals provide specialised referral
services for all the district hospitals in the country. For
conditions that cannot be managed within the country
patients are referred to neighbouring South Africa through
the national referral hospital. Ideally the referral system
is supposed to move from the community level (health centre
or Health Post) to district hospital and then to the
national referral hospitals. Differential fees have been
implemented to facilitate efficiency. At government
hospitals adult patients are charged M20, children M10 for
outpatient fees, while at government health centres adults
are charged M10 and children M5. Currently this fee
structure does not apply to CHAL facilities where fees are
set at the discretion of the management team of each
facility.
Functioning of the referral system has been impeded by
factors such as poor communication infrastructure,
especially at the Health Centre level; ineffective
functioning of some facilities because of lack of human
resources or bad staff attitudes, out of stock drugs,
dysfunctional equipment, poor ambulatory services and other
inefficiencies. As a result people tend to bypass
facilities in search of facilities that will provide what
they perceive as comprehensive care.
As an attempt to strengthen the referral system and
rationalise the distribution of facilities and services
around the country, redefinition of the typology of all
hospitals around the country has been undertaken as part of
the sector infrastructure development reforms
HEALTH SERVICES by
Health
System Level
Health
Posts
Health posts are posts at the community level that are
operated by volunteer community health workers including
traditional birth attendants, community based condom
distributors and other volunteer structures at the community
level. Health posts form the basis outreach services for
communities that have insufficient infrastructure. Health
posts are often used as a meeting place for immunisations
and health education gatherings at the community level.
Some health posts are visited regularly by hospital PHC
teams for supervision and provision of basic curative and
primary health services. On occasion health posts can be
visited by specialised health workers to provide mental and
oral health services. Services at this level are mainly
promotive and preventive and sometimes rehabilitative.
Health Centres
Ideally the health centre constitutes the first contact with
the formal health system. Health centres are supposed to be
staffed with nurse clinicians, a cadre of registered nurses
that has comprehensive skills in preventive and curative
care as well as dispensing. Key activities undertaken in
health centres include immunisations, ante-natal and
post-natal care, familyplanning and other curative and
preventive public health services. Health centres provide
outpatient services only except in the case where there are
waiting mothers’ lodges for pregnant women. Supervision of
community based public health and training of community
health workers are some of the key management
responsibilities of the health centres. Health inspector
work between health centres and hospitals to ensure that
communities are effectively sensitised about good health
practices, particularly those related to personal and
environmental hygiene.
Filter Clinics
Filter Clinics were constructed to relieve the load on
hospitals so that hospital resources could be used more
efficiently, especially in the Maseru district where the
referral hospital also doubles as a district hospital.
Filter Clinics are mini hospitals and were supposed to have
limited inpatient services. However, insufficient staff has
meant that these facilities currently do not offer inpatient
care and do not provide 24 hour services. Filter clinics
offer curative and preventive services which are more
complex than those at health centre level. The combination
of staff at the Filter Clinics includes doctors and those in
Maseru also include Pharmacy technicians and dental staff.
Filter Clinics get support from the hospital for provision
of diagnostic services such as laboratory and radiology
services. Filter Clinics also have an administrative
department.
District Hospitals
Services at this level vary according to availability of
resources such as functional equipment and human resources.
District hospitals are the second entry point into the
second the formal health system. Both outpatient and in
patient services are provided at this level. This level
offers more complex and sophisticated treatment and
diagnostic services as well as primary health care (routine
immunisations, ante-natal and pre-natal care). Specific
services at this level include mental health rehabilitation
and management, minor and major operations, ophthalmic,
counselling and care of rape victims, radiology, dental,
blood transfusions etc. Specialised clinics for
tuberculosis and non-communicable diseases are also
undertaken at this level. All the hospitals except Paray
Hopsital are offering primary prevention of mother to child
transmission of HIV (PMTCT). The intention is that these
services will become a standard service at all hospitals and
health Centres that offer ANC and PNC services. All the
hospitals except Tebellong and Paray hospitals offer ARV
treatment. Like PMTCT the intention is for all facilities
up to health centre level to provide ARV therapy to people
living with AIDS.
Supervision and training of health workers at the health
centre level is another important function of the HSA
management team. Traditional HSA, including health
centres, planning and budgeting also takes place at the
hospital level , however this process is due to change as
District health management teams become operative in all the
districts. For more complex conditions, district hospitals
refer patients to the relevant referral hospital. Queen II
absorbs the general referral while more specialised
referrals are sent to one of the other specialise referral
hospitals. For more details on services at the referral
hospitals please see Referral hospital profile.
Referral Services Profile
QE II National Referral Hospital
Bots`abelo Leprosy Hospital
Senkatana AIDS Clinic
National Psychiatric Hospital
Mohlomi Psychiatric hospital is the national referral point
for mental observation units at the district level. The
bed capacity of this facility is sixty with 30 beds in the
male ward and 30 in the female ward. The hospital was
built in 1964 and it on recommendation by the first Mosotho
Psychiatrist started admitting patients in. The hospital
was officially opened in 1966 by His Majesty King Moshoeshoe
II and named after the former chief adviser and doctor of
King Moshoeshoe I who was famous for his outstanding skills
in the treatment of mentally ill persons. Psychiatric
services have been provided since then and have been
decentralised to all district hospitals except Thaba Tseka.
All district hospitals have an observation and treatment
units with bed capacities ranging from 10 to 12 beds.
These facilities are managed by psychiatric nurses working
with the district medical officers. Consultative,
supervisory and supportive visits are done once every 4 to 6
weeks to the district facilities by the Consultant
registrar/ Psychiatrist from Mohlomi Hospital. At present
inpatient psychiatric services are offered for adults only.
Plans are underway under the health sector reform programme
to refurbish and expand the hospital so that it can
accommodate geriatrics, child, adolescent and forensic
services. Occupational therapy department and a teaching
block are also part of this project. Mohlomi Hospita serves
as a clinical area for mental health placement for
undergraduate nurses and post graduate nurses, students from
the psychology and social work departments at the National
University of Lesotho, Forthare and Freestate Universities.
An orientation programme is also offered for other
categories such as officers from the Correctional Services
department.
Services at Mohlomi Hospital
First consultation at the outpatient clinic costs only M10,
follow up visits and in-patient services are provided for
free. On average, the outpatient attendance is approximately
60-70 patients, while at least 18 patients are admitted per
month, with an average length of stay of 4 to 6
weeks. Services include occupational therapy (leisure, work
related, therapeutic groups, self maintenance skills, home
management skills and financial management skills and
support groups). Other services include psychological
therapy, social services, medico-legal reports for forensic
patients to the courts of justice and community mental
health services. Nursing services include assessment of
patient history for diagnostic purposes; provision of health
education, counselling and support to patients affected
families and offer teaching and guidance services for all
cadres that come to the hospital to gain
experience.
Contact person:
Mathaabe
Ranthimo
Position:
Acting
Director
Telephone: +266-22313744/
22327711
Fax:
+266-
22311104
Email:
mohlomi.hospital@ilesotho.com |
