Lesotho: Assesment of the National Health System
1. Lesotho A Review of the Health System in Lesotho 2. Area: 30,355 km2 Population: 2,067,000 (2009 estimate) Capital: Maseru ( population: 200,000) 3. • Lesotho, is a small rural country in Africa that is a true enclave; it is completely surrounded by South Africa. • This mountainous country is home to the Basotho people. • Altitudes in Lesotho range from 4,500 to over 13,000 feet. • High mountains cover about two thirds of the country. 4. • The capital city Maseru has a population of approximately 200,000, and is home to the main government hospital in Lesotho. • The remainder of Lesotho’s 2 million people live in small rural towns with the majority (81%) of the population living in remote rural villages. 5. Health Services in Lesotho • Healthcare delivery in Lesotho is challenging as a result of the fact that 81% of the population lives in remote rural villages, often several hours walk over rough mountain paths from the nearest clinic. • Access to healthcare in Lesotho is also limited by poverty and by lack of personnel. • Citizens pay directly at the point of service for their healthcare. 6. • Lesotho achieved great strides in improving its health indicators from 1966 to 1990, with life expectancy rising from 40 years to 59 years. • However, Lesotho has been devastated by HIV/AIDS, which has reversed the gains the country achieved in health indicators (with life expectancy dropping to age 44 in 2008, from age 59) (World Bank 2010), reduced the population growth rate, and left no sector of the economy unaffected. 7. The formal system of Lesotho health facilities are divided into: • National (tertiary) 3 • one referral and two specialized hospitals. Any patients with conditions that cannot be addressed at the national level are referred to South Africa. • District(secondary) 18 • Hospitals that receive patients referred from the community level and filter clinics. • Community (primary) levels 188 • includes both health posts and health centers 8. • 42% of the health centers and 58%of the hospitals are government owned. • 38% of the hospitals and 38% of the health centers fall under the control of the Christian Health Association of Lesotho (CHAL), and the remaining facilities are either privately owned or operated by the Lesotho Red Cross. 9. National Level • At the national level, Lesotho has three tertiary-level hospitals: • Queen Elizabeth II Hospital • Mohlomi Mental Hospital • Bots`abelo Leprosy Hospital. • Queen Elizabeth II Hospital is the national referral hospital. Any cases that cannot be treated at Queen Elizabeth II are referred to South Africa. • There is a fourth, large tertiary hospital in the process of being built through a public-private partnership. This will serve as the main referral hospital in Lesotho. It will be substantially larger than Queen Elizabeth II Hospital. 10. • Health posts are run by volunteer community health workers and provide outreach type care, such as condom distribution and immunizations. • Health centers are staffed by nurse clinicians, who provide outpatient primary care. • The large district hospitals provide a variety of outpatient services, including both primary care and specialized clinics (such as HIV/AIDS • and TB clinics), as well as inpatient services. 11. St Josephs Hospital , Roma , built in 1937 as 5 separate single storey buildings. It is a district hospital that serves a population of 120,000 and is 40 km from Maseru the Capital. The Hospital is in a very mountainous area and is in poor physical condition, with serious roof leaks and the consequential damage to the ward ceilings, floors and paintwork. Working with the hospital maintenance staff we completely refurbished 2 hospital wards . 12. Health Expenditure • Lesotho spent an average of 7.7 percent of its GDP on health between 2004/05 and 2008/09 reaching a peak of 8.5 percent of its GDP in 2008/09, which is almost double the average for low middle income group countries (4.5 percent), and well above the (WHO) African Region average of 5.6 percent in 2006. • In per capita terms, there has also been an upward increase from a low US$45.5 from 2004/05 to a high of US$66.3 in 2007/08. • From 2004/5 to 2008/9, Lesotho spent US$54.6 per capita/per annum, which was one and one-half times higher than the US$34 per capita per annum recommended for providing a minimum package of cost-effective interventions.. 13. • This implies that Lesotho is not suffering from an absolute inadequacy of financial resources, but that the country has, and allocates, resources capable of providing quality health care services to its population. • However, this amount, while double the WHO African Region average ($27/annum), remains lower than the average of its peers in the low middle income group ($74) (WHO 2009) 14. 3,222 3851 3867 7164 2817 4150 119 1282 0 2,000 4,000 6,000 8,000 United Kingdom France Germany United States Japan Australia Lesotho Bahrain Health expenditure per capita (2008) in comaprsion Globally Health expenditure per capita (2008) in comaprsion Globally 15. 119 843 147 113 66 86 1053 899 Lesotho South Africa Sudan Nigeria Kenya Chad Botswana Globally Health Expenditure per Capita in comparison to African Countries Health Expenditure per Capita in comparison to African Countries 16. Health Expenditure, % of total GDP ($2 ,179, 350,967 2007-2011: 11.1% 2002-2006 9.4% 17. •Human Resources • Based on last available WHO data 2000) • Physicians • Lesotho 0.5/10,000 • Regional 2.3/10,000 • Nurses & Midwives: • Lesotho 6.2/10,000 • Regional 10.9/10,000 ( 18. In comparison to Bahrain: • Indicators per 10,000 population Physicians • 1997: 14.2 • 2007: 21.4 • Nurses & Midwives • 1997 28.2 • 2007 41.9 19. • Contributing to Lesotho’s difficulties with retaining medical personnel, is the fact that Lesotho has no formal medical education aside from nursing schools. • Most Basotho who attend medical school do so in South Africa, & few return to practice in their country. 20. Basic Demographics 21. HIV/AIDS in Lesotho: • Lesotho has the third highest HIV prevalence in the world - just under one in four people in the country are living with HIV. • In 2009 there were around 23,000 new HIV infections and approximately 14,000 people died from AIDS. • Over half of the 260,000 adults living with HIV in Lesotho are women. • “There are two types of people in Lesotho; those infected and those affected by HIV/AIDS”. 22. • The majority of HIV transmission is heterosexual and mother to child. • Reasons for high HIV rates are multi- factorial, including poverty, social instability, high levels of other STDs, sexual violence and high mobility (particularly migrant labor) 23. • The AIDS epidemic in Lesotho has had a devastating impact on the country. Crippling poverty combined with AIDS has caused average life expectancy to drop to 48.2 years. The impact on individuals, families and the whole nation is being felt as adults become too sick to work, and children orphaned by AIDS. 24. Lesotho’s AIDS effort is now guided by the National AIDS Policy and Strategic Plan for 2006-2011. The government intends to reverse the epidemic by focusing on HIV prevention through condom promotion, prevention of mother-to-child transmission, and providing antiretroviral treatment for all those in need 25. Tuberculosis • Lesotho also suffers from one of the highest rates of tuberculosis infection in the world (634 new cases per 100,000 per year, compared to just 4 per 100,000 in the U.S.) • The majority of people infected with TB in Lesotho are also HIV-positive and nearly 1,000 people each year contract strains of TB that are resistant to all first-line drugs. 26. • According to Lesotho’s Ministry of health: • TB accounts for 31% of institutional deaths • pneumonia 29% • diarrheal diseases14% • HIV/AIDS (which clearly contribute to the above causes of death as well)9% • Pneumoconiosis associated with pulmonary TB 6% • Upper respiratory infection 5% • Diabetes 3% • Head injury 3% • Incomplete abortion 0.5%. • Nutrition is also a major cause of disease in Lesotho, especially • affecting children, with 13% of inpatient admissions resulting from • nutritional deficiencies in children aged 0-4 and 3.5% of admissions • for all age groups. 27. Areas for future improvement • Medical care in Lesotho is largely framed by the nation’s challenges with HIV/AIDS, TB, poverty and topography. • There are many potential interventions that may be taken in order to improve health outcomes. • The most important factors in improving health in Lesotho are reducing poverty and increasing access to primary/preventative care, such as access to free/low cost ART and TB • treatments. 28. • Improvements to roads and transportation infrastructure would likely have the largest impact on Lesotho’s pre-hospital care. The development of a pre-hospital medical system with a centralized ambulance service and trained medical personnel may make a significant impact on health outcomes in densely populated areas of Lesotho. 29. • Recently, a residency program in family medicine was started, which will hopefully lead to better retention of doctors in Lesotho. • With these efforts and continuation of HIV/AIDS and TB prevention and treatment campaigns, Lesotho should have continued increase in average lifespan and improved health outcomes.