Services Availability and Readiness Assessment Integrated Supervision

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Services Availability and Readiness Assessment Integrated Supervision LESOTHO PHC REVITALIZATION SERVICES AVAILABILITY AND READINESS ASSESSMENT INTEGRATED SUPERVISION REPORT – BY THE MOHSW ASSESSMENT/STUDY TEAM For copies of this report please visit www.health.gov.ls or request such copies from the Principal Secretary’s office @ 22312836 or 22326230 For additional copies of this report, please email [email protected] visit our website at www.pitsong.org.ls or call us at 28326777 Report authors: Mamatebele Setefane – MOH Bulara Mojakhomo – MOH Nthati Moorosi – PIIR Mamojalefa Matsoara- MOH Matthew Kukla - HFG Moitlisi Mafaesa – MOH Shoeshoe Lemphane- MOH Tsietso Motsoane - MOH Nthekeleng Motsoane- MOH Katiso Ramalebo – PIIR Themba Fobo – MOH Lebohang Mothae- CHAL Matumaole Ramochela - MOH Mpopo Tsoele - PIIR Recommended Citation: Lesotho Ministry of Health. July 2014. Lesotho PHC Revitalization- Services Availability and Readiness Assessment- Integrated Supervision Report –MoHSW Assessment Team. LESOTHO PHC REVITALIZATION SERVICE AVAILABILITY AND READINESS ASSESSMENT- INTEGRATED SUPERVISION REPORT DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Government or any of its agencies USAID, PEPFAR, and CDC. The view expressed in this publication are those of the Ministry of Health. © Copyright on this document is held by the Ministry of Health. Part(s) of this document may only be cited, copied or used with written permission from the Ministry of Health. July 2014 CONTENTS Contents .................................................................................................................... i Acronyms and Abbreviations................................................................................. v Acknowledgments .................................................................................................. ix Executive Summary ............................................................................................ xvii 1. Background ............................................................................................... 1 1.1 Geo-physical Characteristics ............................................................................................ 1 1.2 Economy and Economic Governance ............................................................................ 2 1.3 Demographic and Socio-cultural Characteristics ....................................................... 4 1.4 Political and Administrative Governance ...................................................................... 5 1.5 Health Services in Lesotho................................................................................................ 8 1.6 Hon Minister’s Priority Statement .................................................................................. 8 1.7 Health Services Organization ........................................................................................... 8 1.8 Ownership of Health Facilities ......................................................................................... 9 1.9 Health Services Decentralization Reform ................................................................... 10 1.10 Community Based Health Services in Lesotho ......................................................... 10 1.11 PHC Revitalization Plan 2011-2017 .............................................................................. 12 1.12 Health Services: Programme Indicators ...................................................................... 12 1.13 Health Systems Challenges: Observations of the HSA 2010 ................................ 15 2. Service Availability and Readiness Assessment.................................. 17 2.1 Purpose, Objectives and Scope ..................................................................................... 17 2.2 Methodology ....................................................................................................................... 18 3. Key Findings and Results ....................................................................... 23 3.1 HTC Services ...................................................................................................................... 23 3.2 Maternal and New born Health and PMTCT Services............................................ 26 3.3 Child Health and Nutrition ............................................................................................. 30 3.4 Family Planning Services ................................................................................................... 32 3.5 Oral Health Services ......................................................................................................... 35 3.6 Environmental Health ....................................................................................................... 37 3.7 Infection Control ............................................................................................................... 39 3.8 Mental Health...................................................................................................................... 41 3.9 Management Systems for Quality Service Delivery ................................................. 42 3.10 Immunization and Surveillance ....................................................................................... 51 3.11 Protocols and Guidelines ................................................................................................. 53 3.12 Records Management and Information ........................................................................ 54 4. Discussion and Recommendations ....................................................... 61 4.1 Leadership and Governance ........................................................................................... 61 4.2 Recommendations: Leadership and Governance ...................................................... 66 4.3 Human Resources Management and Quality Services Provision ......................... 67 4.4 Recommendations: Human Resources and Quality Service Provision ............... 70 4.5 Conclusion ........................................................................................................................... 70 Appendix I: Gender Considerations related to Health and HIV/AIDS in Lesotho ................................................................................................................... 73 Appendix II: Health Facility List .......................................................................... 77 i Appendix III: Summary of Key challenges identified in the Health Sector and recommendations ................................................................................................. 83 Appendix IV: Main Areas Covered by the Provider Interview Questionnaire .................................................................................................................................. 91 Appendix V: Coding .............................................................................................. 93 Appendix VI: Additional Findings ........................................................................ 95 List of Tables Table 1.1. Income and Inequality Indicators in Lesotho, Compared to Sub-Saharan Africa ....................................................................................................................... 3 Table 1.2. Education Indicators in Lesotho, Compared to Sub-Saharan Africa .................... 3 Table 1.3. Demographic Indicators in Lesotho, Compared to the Sub-Saharan Africa Regional Average .......................................................................................................................... 4 Table 1.4. Local Government Structures by District ................................................................... 7 Table 1.5. Facility Ownership by District ...................................................................................... 10 Table 1.6. Reproductive Health Indicators in Lesotho, Compared to the Sub-Saharan Africa Region ............................................................................................................................... 12 Table 1.7. Mortality Indicators in Lesotho, Compared to the Sub-Saharan Africa Region ............................................................................................................................... 13 Table 1.8. Major Causes of Mortality in Lesotho, 2004............................................................. 13 Table 1.9. Top Four Causes of Inpatient Admissions, 2007 and 2009 .................................. 14 Table 1.10. Mortality per 1,000 in Female and Male Adults (Select Countries) ................. 14 Table 3.1. HTC Service Delivery Indicators ................................................................................. 23 Table 3.2. MNH and PMTCT service delivery indicators ......................................................... 26 Table 3.3. Child Health and Nutrition Service Delivery Indicators ........................................ 30 Table 3.4. Family planning service delivery indicators ................................................................ 32 Table 3.5. Availability and Delivery of Oral Health Services .................................................... 36 Table 3.6. Finance and Accounting Indicators .............................................................................. 48 Table 3.7. Immunization and Surveillance Indicators .................................................................. 51 Table 3.8. Records Management and Information
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