Lesotho National Health Policy

Writes Kekeletso Motopi

The Lesotho health services sector is guided by a ten-year master plan that envisages the provision and expansion of the services. The plan titled The National Health Strategic Plan (2017-22), is premised on the contents of the National Health Policy and explains in detail how the objectives of the National Health Policy will be implemented its priorities, and expected outcomes and how the results will be measured. The National Health Policy (NHP 2016) and the National Health Strategic Plan (NHSP 2017-22) are implemented concurrently. The National Health Strategy provides the basis for stakeholder discussion and dialogue on the priorities of the health sector and the basis for partners (both inter and intra-sectoral) to prioritise their programmes and funding plans in the health sector. It also facilitates growth and investment in the health service provision and supply.

The shared vision of this strategy is a global vision that seeks to achieve universal health coverage for people of all ages. This strategy was developed within the context of global health parametres and is informed by the Sustainable Development Goals (Goal 3) and has internalised the goals and targets of the SDGs for health.

The National Health strategy reflects, and has adopted other global and regional strategies and frameworks such as the Paris Agreement on climate change (2015), Global Health Security, building a resilient health system, Global Strategy on Human Resources for Health (Workforce 2030), Engagement with non-state actors, Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), Reducing HIV transmission by 2020, Elimination of Mother-to-Child transmission of HIV and syphilis, the End TB Strategy, WHO Framework Convention on Tobacco Control and Global plan of action on violence are all expressed in the constitution which provides protection to health, equality and justice for all, regardless of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

To ensure the successful implementation of the plan, the government has allocated M1.1 billion to support its implementation for the fiscal year 2023/24.

The National Health Strategic Plan (NHSP) ensures a functional, accountable, transparent and equitable health system. Building a functional health system requires a strong policy and regulatory environment, and a transparent and accountable system of planning, resource allocation, monitoring and evaluation (including research) for better health outcomes.

The plan draws on curbing the spread of communicable diseases. The most common communicable diseases include preventable diseases such as infections and viral hemorrhagic fevers. Covid-19 is one such disease which the plan is focused on. The global pandemic spread across the world in a matter of months and Lesotho tackled it through the provisions of the strategic plan.

The strategic plan also makes provisions for the HIV and AIDS programme. The overarching goal of the HIV and AIDS programme is to achieve universal access to prevention, treatment and care for HIV and AIDS services for the people of Lesotho. In line with the UNAIDS strategy, the MoH strategy targets zero new infections and zero AIDS-related deaths. The previous strategy had four main targets aimed at reducing by 50 percent, the percentage of young people aged 15-24 years who are infected, reducing new HIV infections in children by 90 percent and reducing HIV-related deaths by 25 percent (all compared with a 2009 baseline). Lesotho is said to have a generalised HIV epidemic with 25% of adults aged between 15-49 years being HIV positive. About 310,000 persons (adults and children) are living with HIV and AIDS in Lesotho.

The prevalence rate is higher in women (30%) than in men (23%). HIV prevalence in women is highest between the ages of 35 and 39 years at 45.5% and in men at 43.5%9 between 40 and 44 years. Key populations with high HIV prevalence include female sex workers (FSWs), men sleeping with men (MSM), migrant and factory workers and transgender persons. HIV prevalence in key populations is higher than in the general population with a prevalence of 72% among FSW, 43% among factory workers and 33% among MSM. HIV incidence is less in women than in men. It is estimated that there are 18000 new HIV infections and about 9900 HIV and AIDS related deaths each year.

Notably, the country has also made enormous progress in the fight against HIV and AIDS. It has surpassed the UNAIDS 90-90-90 and has exceeded the second and third 90 targets, achieving 90-97-92. These findings position the country well as it aims to achieve the even more ambitious UNAIDS target of reaching 95-95-95 targets by 2025.

While Lesotho, like many of its Least Developed Countries ( LDCs ) peers is grappling with a number of health challenges, it has also prioritised improving its health services by increasing access through infrastructure development and improving necessary skills and technology at the local level to address such and reach its target goals.

For the current financial year, the government has proposed M3.2 billion for financing health sector programmes. This will among others allow deployment of the health workforce in critical areas, procurement of critical equipment in hospitals, and implementation of disease prevention programmes. The planned works will also proceed for the cancer centre being established for the country.

Other critical programmes include the global move to diagnose all missing TB cases and enroll them for treatment through Operation Hlasela lefuba launched by the Ministry of Health in February 2023. The operation is ongoing.

Plans are underway for the country to open doors to its first cancer treatment facility in 2024 to provide services locally rather than sending patients abroad for treatment. With support funding for the facility provided by the Lesotho government and specialist medical staff already undergoing training with the International Atomic Energy Agency (IAEA) in Vienna, Austria, the African country of 2.2 million people is in a good position to start building the centre in the capital, Maseru, and purchase the necessary equipment. This centre would save the country approximately US$7 million it spends annually on sending its cancer patients to South Africa and India for treatment and care. Completion of the first stage of construction will enable the provision of chemotherapy and radiotherapy for around 1,000 patients a year, with some accommodation available for patients requiring longer periods of treatment.

The envisaged second phase of the construction will extend the centre’s capacity to provide services for more walk-in patients. It will also add diagnostic and nuclear medicine facilities for both cancer and cardiovascular diseases. Cancer is increasingly both a health and development issue for many low and middle-income countries, with a growing number of cases putting more pressure on the government and family resources.

According to the International Agency for Research on Cancer, Global Cancer Observatory, the number of people expected to develop cancer in Lesotho each year will grow by almost a quarter by 2030, with a similar annual rise in related deaths. Lesotho is one of 28 African countries which does not currently provide radiotherapy – an essential tool in the treatment of cancer.

Apart from the cancer clinic, the country is also planning a new eyecare department at the Maseru District Hospital and Eye Clinic. The multi-million Maloti project is expected to benefit at least 400 000 people in Maseru and other districts. The state-of-the-art, 200-bed Maseru District Hospital and Eye Clinic is anticipated to start operating in December 2023. It is part of the reconstruction of the old Queen Elizabeth II Hospital. The hospital is expected to provide services including eye care, cancer, tuberculosis (TB), HIV, and non-communicable diseases including telemedicine platforms. The hospital will also have training facilities and dormitories for trainee doctors and nurses. It will feature state of art medical equipment and act as a national referral hospital, working in collaboration with the Queen ‘Mamohato Memorial Hospital to treat patients. The hospital construction is being funded through a Forum on China-Africa Cooperation (FOCAC) programme. The platform among other things seeks to promote the China-Africa relationship through collective dialogue and practical cooperation.

The Lesotho health plan is open for Public-Private Partnerships (PPP) that cover service delivery, supply chain and hospitality services. In 2012, the Government of Lesotho (GoL), with support from the International Financial Corporation (IFC), undertook a PPP project to strengthen healthcare waste management in 15 health centres and two district hospitals. The project was to pilot the collection, transportation and disposal of healthcare waste from the selected health facilities.

The GoL, with funding from the Millennium Challenge Account (MCA), started a project to refurbish 154 health facilities. With support from IFC, a PPP project was initiated to address facility management, Information, Technology and Communication (ICT) including connectivity in 165 health centres.

The MoH has a memorandum of understanding with the Christian Health Association of Lesotho (CHAL) and selected private health facilities to provide health services.

The country is not new to PPP partnerships. Its maiden PPP arrangement was to design, build and operate the Queen Memorial Hospital (QMMH) for 15 years. The PPP signed in 2009 opened a new era for private sector involvement in healthcare in Africa, and was seen as the International Finance Corporation (IFC)’s flagship model to be replicated across the continent.

Lesotho embarked upon this partnership as a strategy to rebuild the country’s failing network of public health facilities. In 2012, the health network provided services to approximately 375,000 outpatients and 23,000 inpatients. Health sector public–private partnerships (PPPs) come in a variety of forms, from the outsourcing of specific support services such as catering, to more complex arrangements that include financing, building, designing and facilities management of hospitals.

Under the Queen ‘Mamohato Memorial Hospital PPP, which has since collapsed, Netcare was contracted to treat all patients presenting at the Queen ‘Mamohato Memorial Hospital, up to a maximum of 20,000 inpatients and 310,000 outpatients annually. Patients paid the same user fees as they would in any public facility. Certain services such as transplants, elective cardiac and vascular surgery, chemotherapy, and radiotherapy were excluded from the contract for reasons of affordability. Like the old Queen Elizabeth II Hospital, under the PPP the new hospital was contracted to function as the country‘s clinical teaching facility for health professionals. In return, the government paid an annual unitary fee that covers capital repayment and service delivery costs. The fee would be adjusted only for inflation or if additional services beyond those in the contract are agreed and incorporated. The agreement provided that, if Netcare failed to uphold agreed performance standards, the government could make penalty deductions from this fee. Any patients served in excess of the maximum number covered by the contract were to be charged to the government at a rate of $4.72 per outpatient and $786 per inpatient (at 2007 prices and excluding VAT and annual inflation).

The sector has a diverse structure, covering funding, regulation and the delivery of health services featuring a combination of private and public sector participation, mainly run by government. Non-governmental organisations, such as religious bodies, Lesotho Red Cross Society and others, also shoulder a portion of the work in the direct provision of health services.

Health services are delivered across primary, secondary and tertiary levels. In total, there are 286 health facilities across the country, 265 primary healthcare centres, 20 general and district hospitals and a tertiary referral hospital, Queen ‘Mamohato Memorial Hospital (QMMH) located in the capital, Maseru. The government operates 40 percent of the primary health centres and 55 percent of the hospitals.