Ministry of Health and Social Welfare - Partners in Service Provision

The Christian Health association was established in 1974, though Christian based health providers existed long before then. CHAL is an amalgamation of Christian churches that are committed to the provision of quality health services to Basotho particularly in hard to reach places around the country. CHAL is the largest contributor to service delivery in Lesotho, serving approximately 40% of the population. The denominations that make up the CHAL are Catholic, Lutheran, Seventh Day Adventists, RCC, ?????. CHAL facilities include eight hospitals and 79 health centres. Implementation of the primary health care strategy significantly integrated coordination and collaboration in service delivery, between CHAL and the Ministry of Health. The Health service areas concept which implies ‘health district’ meant that within a given health district there are CHAL and government health centres and the hospital in charge is responsible for supervising all health centres regardless of whether it is a CHAL or government facility. Thus policy formulation and implementation in the Ministry often is always taken in partnership with CHAL.

CHAL is constituted of an Executive Board which oversees the overall policy framework of the organisation and provides management support to the Secretariat. The secretariat provides guidance to CHAL facilities through participation in Hospital Boards and has become increasing active in the processes such developing and implementing systems of accountability and transparency to facilitate adoption of a functional memorandum of understanding between CHAL and the government of Lesotho. This is an initiative being undertaken in partnership with the Ministry under the Health Sector reform programme.

CHAL facilities generate their own revenue through user fees and grants, including the government from various sources. In the past the government provided for CHAL support through a subvention under the recurrent budget of the Ministry of Health & Social Welfare. The subvention to CHAL was used to pay minimum salaries of technical staff such as doctors and nurses. In March 2003, this arrangement was replaced with the Supplementary Emergency Funding Facility (SEFF), which was a response to a financial crisis facing most of the CHAL facilities because of dwindling resources from grants from different sources. The objective of SEFF was to provide temporary financial support to CHAL facilities so that the quality of services to be provided could be improved to the minimum acceptable level. The SEFF arrangement is supposed to last for three years following after which it is expected that these facilities will have reach the acceptable quality and therefore qualify for a more sustainable agreement with the government, in the form of a memorandum of understanding. The amount of SEFF received by each facility is calculated at 20% of the overall operating costs, including salaries. In 2004/05 total amount to CHAL was M37. 5 million, which is approximately 14% of the total recurrent budget of the Ministry.

Red Cross Lesotho

The mission of Red Cross Lesotho is guide by the international Red Cross which endeavours to improve the situation of the most vulnerable people. The specific mandate of Red Cross is to strengthen the capacity of communities to carry out effective disaster preparedness, health and social programming. The Lesotho Red Cross was established in 1971 with the objectives of improving health and well being, promoting participation of the youth in relief and assisting victims of natural and manmade disasters. Currently, Red Cross is also active in HIV/AIDS initiatives in the country.

Red Cross work in Lesotho includes distribution of relief items such as clothing and food; drought mitigation and income generating activities; water safety; first aid training; blood donor recruitment and capacity building of youth volunteers. In the health sector Red Cross has four Health Centres in the rural areas of Leribe, Maseru, Mokhotlong and Mafeteng districts, which provide comprehensive primary preventive, curative and rehabilitative services. Red Cross is also involved in preventive HIV initiative among the sexually active age groups including the youth through training of peer educators, production and dissemination of HIV/AIDS material, distribution of condoms and provision of counselling and home based care services for infected and affected persons.

Red Cross Lesotho receives support from the government through payment of salaries of professional staff working to further the objectives of the Ministry. In 2004/05 Red Cross received a subvention amounting to M260,000

Blue Cross Lesotho

The Thaba Bosiu Centre was established in 1989 by the Lesotho Evangelical Church in partnership with the government of Norway and the international Blue Cross Association. Overtime the Centre has gained the support of various other organisations including other Christian denominations. The mandate of the Centre is divided into two approaches, prevention of substance and alcohol abuse as well as rehabilitation of person and families affected by alcohol and substance abuse. Prevention is promoted through production and dissemination of teaching materials. Prevention strategies also include creation of employment and leisure activities for the youth. Rehabilitation is directed at alcoholics as well as the children of alcoholics and follow- up of clients once they have left the centre. Rehabilitation approaches include vocational training and counselling. The Thaba Bosiu Centre historically received support from government through a subvention which was used to pay salaries of technical staff while all other costs were covered by the Blue Cross. This arrangement came to an end when the Norwegian project came to an end in December 2004 and in March 2005 the government was obliged to take over the full running cost of the Centre. In 2004/05 the budget for the Thaba Bosiu centre under the recurrent budget of the Ministry was M1,780,000.

Lesotho Planned Parenthood Association

Lesotho Planned Parenthood Association was established in 1968. It a non-governmental, non-profit sexual and reproductive health organisation which is committed to the provision of quality sexual and reproductive health information and services to men, women, youth and marginalized groups; prevention and mitigation of HIV/AIDS; advocating for sexual and reproductive rights. The original driving force behind the mission of LPPA is the empowerment of women in taking control of their fertility issues. Establishment of the LPPA function of population control was the high prevalence of malnutrition and the deterioration in the health of mothers and their children culminating into high infant, child and maternal mortality. These problems were attributed to too frequent childbearing, improper spacing of children and malnutrition. LPPA has contributed significantly to raising family planning awareness and acceptance. LPPA continues to play a significant role in all family planning services in the country and it covers eight out of the ten districts in the country through its eight static clinics.

As a pioneer of sexual and reproductive health services, LPPA supplements government efforts in the reduction of infant, child and maternal mortality and morbidity. This supplementation has taken the form of improving HIV/AIDS competency among youth, men and women, increasing access to quality integrated sexual % reproductive health services; formulation of information and policies related to abortion; voluntary counselling and youth involvement in formulation and implementation of policies. LPPA has also contributed to the development of Lesotho National Population Policy of 1994, the Reproductive Health and the Gender policy. The LPPA has also joined the Ministry in the fight against the AIDS pandemic. The association is also involved in initiatives to empower the youth, through establishment of the Youth Resource Centre in Maseru, which has served as a learning centre for adolescent health corners established in government health facilities at district level.

Through the German Government funded project for sexual & reproductive health, the LPPA has received material support from the government, through the Ministry of Health & Social Welfare. This support has taken the form of contraceptive drugs and supplies, equipment, maternal health equipment, training of peer educators as well as educative materials and equipment.