 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
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District Health Package Document
Strategic Framework for Decentralisation MOHSW
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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 (STDs) 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 STDs.
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
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TB Review Document
TB Policy Framework
Strategic Plan for DOTS Expansion in Lesotho, 2003
Contact person Dr M Letsie
Position Head, Disease Control
Telephone +266 - 22325314
Fax +266 - 22322445
Email:
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
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Family Health Annual Report, 2004
Reproductive Health Policy
Adolescent Health Policy
EPI Policy
EPI Financial Sustainability , 2004
Contact person Bosielo Majara
Position Head, Family Health
Telephone +266 - 223323538
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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
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National AIDS Policy & Strategic Plan
Sentinel surveillance report, 2004
STI training manual
Community Home based care manual
Guidelines (VCT,PMTCT, ART)
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Environmental Health
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Health Education
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