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Kingdom of Lesotho Report on the Quality And KINGDOM OF LESOTHO REPORT ON THE QUALITY AND RESPONSIVENESS OF HEALTH SERVICES TO MEET THE NEEDS OF WOMEN IN CRISIS SETTINGS CONDUCTED BY DR. MPOLAI MASAILA MOTEETEE WHO JUNE, 2005 MMM Lesotho June 20005 i Acknowledgements I would like to foremost thank the Honourable Minister of Health and Social Welfare as well as the Management of the Ministry of Health and Social Welfare for allowing the study to go on as well as including some of the government health facilities in the study. My gratitude also goes to the Management of the Christian Health Association of Lesotho, for also allowing us to include their facilities in the assessment. To the District Secretaries of Maseru, Mokhotlong and Quthing, without whose support fieldwork would not have been possible I extend my deepest words of appreciation. The Chiefs of the involved villages were especially co-operative and flexible despite the short notice, to allow us entry and facilitate our village visits; I am thankful for their support. The women (and some men) included in the sample, focus group discussions, key informant as well as exit interviews, were very patient and understanding; I thank them for their willingness to provide the entailed information. A special word of appreciation is extended to the Chairperson Ms. Ntilo Matela (May Her Soul Rest in Peace), and Members of PLOWA for their decision to share their experiences with us. To the health workers who despite their busy schedule, spared time to hold discussions with us as well as organizing focus groups, I congratulate them for their willingness to serve and interest in the welfare of women of this country. I also extend my appreciation and thanks to the Sampling Expert as well as the Programmer for their support; without you, this study would have not been what it is. I thank the Supervisor and Interviewers for their dedication and understanding. Let us hope that, through you, more information will be available for decision making towards improved care and support of women in Lesotho. As part of a regional study, let us hope that Lesotho’s contribution will add value to the objectives. I also thank and express my appreciation to all the UN agency, bilateral partners, and NGO officers who spared their time to share information with me. My appreciation goes to the WR and the WHO Lesotho team for their support and encouragement. I am grateful to WHO Geneva for affording me the opportunity to lead this study in Lesotho. I extend a special word of gratitude to the Honourable First Lady Mrs. ‘Mathato Mosissili and the Honourable Minister of Gender and Youth, Sports and Recreation Mrs. “Mathabiso Lepono, for finding time in their busy schedules to respond to my questions. Finally yet importantly, I thank my husband, daughter, niece and nephew for their support and inspiration. MMM Lesotho June 20005 ii Table of Contents Item Page i. Acknowledgements i ii. Table of Contents ii - vi iii. List of Tables and Figures vii - ix iv. Acronyms x - xi v. Concepts and Definitions xii - xiii vi. Executive Summary xiv - xxi Chapter 1. Introduction 1 - 6 1.1 Background 1 - 5 1.2 Objectives of the Study 5 1.3 Structure of the Report 5 - 6 Chapter 2. Literature Review 6 - 15 Chapter 3. Methodology 15 - 17 3.1 Sampling 15 - 16 3.1.1 Probability Sampling Techniques 15 3.1.2 Stratification 15 3.1.3 Sample Size Determination 15 - 16 3.2 Description of Data Collection Methods 16 - 17 3.3 Data Processing and Analysis 17 3.4 Limitations of the Study 17 Chapter 4: Key Findings on Constraints and 18 - 48 Challenges to Women’s Access to Health and Basic Services Community Level 18 - 33 4.1 Economic Factors and Impact of Health 18 - 23 MMM Lesotho June 20005 iii Care Financing 4.1.1 Affordability of Services 18 - 19 4.1.2 Penalties for Non-payment 19 - 20 4.1.3 Perception of Women of the Magnitude of Food 20 - 21 Insecurity and on Factors Contributing 4.1.4 Women’s Occupations and Level of Education 21 4.1.5 Opportunities Available for Women for Gainful 22 Employment 4.1.6 Women’s Capacity to Decide on Resource 22 - 23 Allocation 4.2 Socio-cultural factors 23 - 26 4.2.1 Socio-cultural Norms that Discourage or Inhibit 23 Health Services Utilization 4.2.2 Available Social/Legal Systems for Protection 23 - 26 of Women Against Sexual and Gender Based Violence 4.3 Physical Access Barriers 26 – 33 4.3.1 Average (mean) Distance to Nearest Health Centre 26 - 27 4.3.2 Average (mean) Distance to Nearest First Referral 27 - 28 Hospital 4.3.3 Average (mean) Distance to a Referral Health Facility 28 Offering Emergency (including surgical) Obstetric Services 4.3.4 Availability of Ambulance Services for Emergency 28 Obstetric Cases 4.3.5 Affordability of Ambulance Services 28 4.3.6 Average (mean) Waiting Time for Ambulance Services 28 4.3.7 Availability of Systems or Community Mechanisms 29 for the Provision of Transport for Emergency Cases 4.3.8 Range and Quality of Health/Social Services Available 29- 30 MMM Lesotho June 20005 iv to Women and Girls at Community Level 4.3.9 Proportion of Women who have Accessed Family 30 Planning Services 4.3.10 Availability of Trained Community Health Workers 31 or Volunteers 4.3.11 Access to Sanitary Facilities 31 4.3.12 Access to Safe Water Supply 32 4.3.13 Access to Food aid 32 - 33 National Level 33 - 38 4.4 Factors Related to National Health System 33 - 38 and Policies 4.4.1 Impact of Financial Resource Allocation Criteria 33 on the Quality and Availability of Services for Women 4.4.2 Effects of SWAP on the Quality of Women’s Health 33 Services 4.4.3 How the Issues of Contracting out Health Services 34 Affect the Quality and Availability of Service Relating to Women’s Health 4.4.4 Effect of Policies on Eligibility for Health Services 34 4.4.5 Effect of Policies on Eligibility for Exemption to User 34 Fees Payment on Women’s Access to Health Services 4.4.6 Fora (forum) for Participation (or voice) of Women 35 Concerning Issues Pertaining to Service Delivery including Women Living with AIDS 4.4.7 Availability of National For a (forum), Deliberate 35 Policies and/or Monitoring Bodies to Address Ills that Affect Women’s Health 4.4.8 Effectiveness of Statutory, Customary, and By-laws 36 - 37 Enforcement Meant to Offer Legal, Physical, and Social Protection to Women and Girls 4.4.9 Availability of Civic Education on Women’s (human) 37 MMM Lesotho June 20005 v Rights Related to Sexual and Gender Based Violence and Gender Related Inequalities 4.4.10 Access to Legal Representation in Matters Related to 37 Sexual and Gender Based Violence 4.4.11 Availability of National Policies, Guidelines and 37 - 38 Protocols for the Prevention, and Management of Sexual and Gender Based Violence Victims 4.4.12 Availability of Health Information Management Systems 38 that Capture Data for the Comprehensive Monitoring and Evaluation of the Status of Women’s Health Services including Sexual and Gender Based Violence (in addition to maternal morbidity and mortality records) Facility Level 38 - 48 4.5 Factors Relating to Service Delivery Level 38 - 48 (policies, strategies and resources) 4.5.1 Existing Referral Service Policies that Prevent Women 38 - 39 from accessing Health Services 4.5.2 Barriers in accessing Health Services Pertaining to Opening 39 - 40 and Closing time 4.5.3 Health Facility Basic Infrastructure, Logistics And 40 Environment Embracing Concerns associated with 4.5.3.1 Availability of Privacy and Confidentiality 40 4.5.3.2 Availability of Life Saving Drugs 40 - 41 4.5.3.3 Availability of Basic Equipment 41 4.5.3.4 Availability of Sanitary Facilities 41 - 42 4.5.3.5 Availability of Communication Mechanism 42 4.5.4 Availability of, and Access Issues Related to Diagnostic 42 - 43 Facilities and Services 4.5.5 Availability of IEC Services such as HIV/AIDS 43 4.5.6 Scope and Quality of Health Services 44 - 45 4.5.7 Response of Health Care Providers to Socio-cultural Norms 45 - 46 4.5.8 Availability of Psycho-Social Counselling, Mechanisms 46 for Confidential Complaints and Other Support Services MMM Lesotho June 20005 vi for Victims of Gender-Based Violence 4.5.9 Availability of Policies, Guidelines and Protocols for the 46 Prevention, and Management of Sexual and Gender-Based Violence Victims 4.5.10 Availability of Human Resources 46 - 47 4.5.11 Inhibition of Access due to Ills Pertaining to Health 47 Workers’ Attitudes 4.5.12 Availability of Health Information Management 47 - 48 Systems (HIMS) that capture Data for Monitoring and Evaluation of the Status of Women’s Health Services in Totality including Gender Based Violence 4.6 Observations and Conclusions 48 - 52 Chapter 5: Organizations Providing Health and Basic Social 53 - 54 Services to Women Chapter 6: Recommended Components of a Health Assessment 55 - 56 Instrument that would be Considered Locally Relevant and Useful Chapter 7: Recommendations for Action to Increase Women’s 57 - 60 Access to Health and Related Basic Social Services, in the Specific National Context Chapter 8: References 61 - 63 Chapter 9: Appendices 64 - 87 9.1 Questionnaires 64 - 66 9.2 Tables and Figures 67 - 87 9.3 Other Relevant Materials 87 MMM Lesotho June 20005 vii List of Tables and Figures 1) Tables on Respondents to structured Questionnaires Table Number Title 1 Distribution of women by marital status 2 Distribution of women by urban and rural abode 3 Distribution of women by marital status 4 Distribution of women by school attendance 5 Distribution of women by level of education 6 Cross tabulation of women by level of education and ecological zone 7 Cross tabulation of women by urban/rural abode
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