«LESOTHO HEALTH POLICY - 2011 Page1 1|Page Table of Contents List of Acronyms Foreword 1.0 Situation Analysis 1.1 Health Profile, Challenges and ...»
GOVERNMENT OF LESOTHO
LESOTHO HEALTH POLICY - 2011
Table of Contents
List of Acronyms
1.0 Situation Analysis
1.1 Health Profile, Challenges and Emerging Problems
1.1.1 Health Profile
1.2 Current Health Policy Appraisal
1.3 Organization and Structure of the National Health System
1.5 Health Services Access and Utilization
1.7 Users’ Demand and Participation
1.8 Strengths, Weaknesses, Opportunities and Threats (SWOT)
1.9 Main Health Policy Issues and Major Challenges
1.10 Health Needs and Priorities
1.1.11 Socio Economic Environment
2.0 Vision, Mission, and Goal of Health Sector
3.0 Values and Guiding Principles
4.0 General Policy Objectives
5.0 Policy Orientations
5.1.1 HIV and AIDS
5.1.2 Sexual and Reproductive Health and Rights
5.1.3 Child Survival and Development
5.1.5 Environmental Health
5.1.6 Emergency and Humanitarian Action
5.1.7 Occupational Health
5.1.8 Health Education and Promotion
5.1.9 Pharmaceutical Services and Medical Technologies
5.1.10 Communicable and Non-communicable Diseases
5.1.11 Oral Health Services
5.1.12 Mental Health Services
2|Page 5.1.14 Referral Services outside the Country
5.1.15 Traditional Health Services
5.2.1 Human Resource Development (HRD)
5.2.3 Health Financing
5.2.4 Health Infrastructure
5.2.5 Quality Assurance
5.2.7 Health Management and Information System (HMIS)
5.2.8 Sector Monitoring and Evaluation
5.2.9 Information Communication Technology (ICT)
5.2.10 Health Regulation
5.2.11 Community Based Health Care
5.2.12 Partners’ Coordination
5.2.13 Public Private Partnerships
6.0 Implementation Framework
6.1.1 Role of MOH
22.214.171.124 Central Level Activities
126.96.36.199 Local Level Functions
6.2 National Council for Health
6.3 Management of Health Facilities
6.3.1 Hospitals/Filter Clinics
6.3.2 Health Centres
6.4 Public-Private Partnership
6.4.1 Partnership with CHAL and LRCS
6.4.2 GOL’s Partnership with Other Private Sector Bodies
6.4.3 Partnership with Traditional Health Practitioners
6.5 Implementation Arrangements
7.0 Monitoring and Evaluation of the Policy
Annex 1: Indicators for measuring key outcomes:
Annex II: Fact Sheet
Annex III: Resources
Annex IV: Synopsis of Specific Programmes
The Ministry of Health and Social Welfare is charged with the responsibility of policy Formatted: English (Zimbabwe) formulation and strategies for the delivery of health and social welfare services, with the ultimate goal of ensuring that every Mosotho has the opportunity for good health and an acceptable quality of life.
The Ministry has therefore undertaken to review its first policy developed in 2004 in order to further restructure its health system, and to meet the multiple challenges faced by the health sector today. This document attempts to capture some radical changes that must be implemented to make the health system not only responsive to the needs of Basotho, but more importantly, to guarantee sustainability of the system to carry out the sector’s mandate.
The document is a product of several months of consultations with the major stakeholders and implementors. The consultations started with group discussions with the selected districts whereby Hospital Management Teams, District Health Management Teams and selected members of Community Councils were met. The Technical Working Group was established at the heardquarter level to oversee the process ; review sub-sector policies ; undertake literature review of several studies conducted during the reform process and the tenure of the policy under review ; align the policy with the National, Regional and International policies and develop a preliminary policy document. The consultant was engaged to analyse and synchronise the information into a refined policy document through conducting a series of consultations with the Senior Management, Heads of Programs and conducting consensus workshops to be able to come up with the draft document. The Ministry is confident that this wide participation in the preparation of the document guarantees ownership and commitment of all stakeholders and the implementors of the policy.
I would like to express my deepest appreciation to all those who have been involved in supporting this important process and the excellent work that has been accomplished.
1.0 Situation Analysis Lesotho’s vision 2020 and Development Plan present clear Government guidance and challenge to formulating sector development policies and plans. The UN Millennium Declaration and other regional declarations called on countries to focus development policies on poverty reduction, as well as rededicate to and revitalize primary health care and health systems strengthening. As countries work towards meeting goals and targets related to global health challenges, it has become increasingly clear that strong health systems are essential to delivering high-quality, accessible, sustainable, and safe health services with an equity and human rights focus. A review of Lesotho’s Health and Social Welfare Policy (2004) therefore takes into account the dynamic environment and attendant challenges towards guaranteeing optimal health for her people with careful examination of the current health profile and state of the health system as a starting point.
1.1 Health Profile, Challenges and Emerging Problems The Population and Housing Census of 2006 recorded a population of 1,877,889 people for Lesotho. The GNP stood at US $ 1970 with a total health per capita spending of about US$ 50.
Poverty remains widespread in Lesotho; the Household Budget Survey of 2002/03 found that 29.1% of households were ‘very poor’ and 50.2% ‘poor’ in 2002/03. Inequality of income and consumption remains very high (especially considering urban rural differentials).
The country was headed towards attaining herd immunity levels in vaccination coverage before it experienced faltering in the past half a decade; malnutrition has however recorded encouraging decline during the same period. Wasting as well as underweight categories have declined from 4.3% and 19.8% respectively (in 2004) to 3.8% and 13.2% respectively (in 2009). Chronic malnutrition has decreased from the above 40% level (LDHS 2004) to 39 (recorded in LDHS 2009). This declining trend in nutrition indicators has to undergo significance testing despite pointing in the right direction. Immunization coverage improvement during the first half of the decade showed decline between LDHS 2004 (total 67.8%) and 2009 (61.7%).
Life expectancy at birth for males was 39.77 and females 42.281; this represents a decline due to high prevalence of HIV (232 per 1000 adults 15-49 years) and TB (490 per 100,000 population) accounting for high adult mortality even upon excluding the estimated high maternal mortality (762 as per DHS 2004 and 1,155 as per DHS 2009). The under fives mortality rate has increased to 117 (LDHS 2009) as compared to 113 in 2004. Mortality in the post-neonatal period has been reported to have increased (LDHS 2009) even though IMR remained the same figure (91 per 1000 live births) between 2004 and 2009. The country’s
health profile2 however gives the following as the main causes of deaths under five years:
Prematurity tops the list, followed by birth asphyxia pneumonia, neonatal sepsis and diarrhea.
Page9 1 GOL MOFDP Bureau of Statistics. 2006 Lesotho Population Census Published June 2010.
2 Lesotho Country Profile 2008 www.who.int/countries
Considering the top position of HIV and AIDS, the occurrence of trauma and prevalent anaemia mortality among adults (table 2 above) and children (table 3 below), blood donors recruitment for the supply of safe blood becomes an important issue for policy and strategy. The under five nutritional status is a good pointer of food security. Improvements in nutrition indicators have been noted but prevalence of both chronic and acute malnutrition continue to show up. Vitamin A deficiency rate is 13.4%; the prevalence of goiter is 43% among school children and 7% in women of child-bearing age.
that 29.1% of households were ‘very poor’ and 50.
2% ‘poor’ in 2002/03.
3 Survey on Prevalence of Hypertension and Diabetes in Lesotho, 2001 4 Lesotho Health System Assessment 2010 pp 48.
Vulnerability is very high in Lesotho; 553 000 Basotho were unable to meet their annual food requirements after the drought of early 2007 (Food Security and Vulnerability Monitoring Report of June 2007).
1.1.3 Emerging Health Problems:
HIV related conditions and Stigma.
• Obesity and concurrent NCDs • MDR/XDR Tuberculosis • Trauma due to Road Traffic Accidents and Assault.
1.2 Current Health Policy Appraisal The current Health and Social Welfare Policy has existed and continued to be used in draft status since 2004. Its basis has largely been the commitment to the Alma Ata Declaration of 1978 (on Primary Health Care) which the country adopted in 1979 by creation of 18 Health Service Areas, building further on the Country’s experience with making basic health care services available nearest to the population dating back to 1975. Fuller implementation of the current policy has been limited by lack of its formal launch even though it has been referred to in guiding the sector strategy and various programmatic policies. Since 2004, Lesotho has been in process of transition from Health Service Areas (HSA) to ten districts managed through the District Health Management Teams.
Impact of the draft policy has been observed through the transition from HSAs to District as administrative bodies to further improve access, equity and promoting community involvement and participation. This existing draft also guided planning in the programmes and facilitated resources mobilization for programmes implementation. There has been a marked level of adherence to the policy in its draft form through programmes strategic plans, e.g.
establishment of a functional Oral Health programme.
In line with the GOL policy the main goal of reforms is to decentralize accountability and responsibility for delivery of health care services to local authorities to increase accessibility, equity, efficiency as well as strengthen ownership. The Ministry has looked into capacity building issues for the reform both at the centre and at the local government level. Furthermore the Ministry has appointed a decentralization coordinator who provides technical and managerial support to the programmes on a daily basis and ensures alignment of the health services decentralization with the broader National Decentralization Action Plan.
At district level 10 DHMTs have been established to provide technical leadership to district operations. Most DHMTs have about 60% of the core staff, 30% are in dedicated offices and all of them prepare annual operational plans to guide their activities. To date however there is no evidence that the indicators planned have changed significantly as the process is still at its infancy and accountability for performance is being pushed by Government and Development Partners.
Page14 The policy had no M&E outline to it. Structures or committees charged with reviewing, adapting, or changing Health Information System (HIS) indicators are typically convened on an ad hoc basis. In the absence of a standing committee or task force charged with organizing
Rationale for Updating and Reviewing the Policy:
Operating in a policy environment which is dynamic requires adjustment to changes in sociocultural interactions, global financial turbulences, population profiles and factors influencing demographic trends. Recourse to Primary Health Care (PHC) and emerged importance of Health Systems Strengthening puts the country on course with implementing the Ouagadougou Declaration on PHC and Health Systems passed by WHO-AFRO Member States (April 2008): The main thrust to getting flagging health indicators back on track and attaining better health in Lesotho. Emerging challenges dictate stronger policy measures followed by determined drive for planned actions based on clear set of priorities. The HRH problems of supply, deployment, retention and market stabilization present an ominous threat to the health system if left unattended for much longer. A rising disease burden and workload at health facilities from HIV and AIDS, Tuberculosis resurgence along with drugs resistant strains need urgent and more determined attention. Management capacity has to be built to meet the growing needs and burden in the health system, especially when considering the current reality of low budget utilization against planned programmes, epidemiological transition mixing communicable diseases with Non-Communicable Diseases, and the complex problem of inequity (of allocation, access, utilization and outcomes).
The foregoing set of issues requires not only review of policy measures, but also coherent corresponding strategies to guide operational planning and action at all levels of the health sector. Likewise some of the measures will need legal enforcement which may require revisiting existing Acts and Regulations in terms of their sufficiency to effectively support policy implementation. In the process of review due attention has been given to harmonization and alignment to National Vision and Development Policy overall.
Review of the policy and appraisal of current strategic plan is an ongoing process aimed to inform the production of the next strategy 2012-2022.
Main Priorities of the Current Policy The outlined district health package and targeted health problems and diseases that account for a high burden give a sense of the policy and plan priorities. Included in the district health