Q&A: National Health Reform in Lesotho Continues to Expand, Evolve

PIH Lesotho’s Drs. Melino Ndayizigiye and Afom Andom discuss the successes and challenges to reach universal health coverage

Posted on Apr 13, 2022

Dr. Melino Ndayizigiye speaks with staff
Dr. Melino Ndayizigiye (center), executive director of PIH Lesotho, inside the Southern Africa Tuberculosis Health System Strengthening van. Photo by Mpho Marole / Partners In Health

In 2014, a health reform model was piloted in four districts in Lesotho. Now, it’s present nationwide. The decision to expand to all ten districts was due to many achievements, including a substantial increase in outpatient visits, HIV treatment enrollment, and facility-based deliveries.  All of these successes, among many others, are bringing the mountainous nation closer to universal health coverage. This is possible because of a strong partnership between Partners In Health Lesotho and the country’s Ministry of Health.

Dr. Melino Ndayizigiye, executive director of PIH Lesotho, and Dr. Afom Andom, clinical director, have helped plan and implement the model. In the interview below, which has been edited for clarity, Drs. Ndayizigiye and Andom discuss the past, present, and future of the National Health Reform.

What is the history of the National Health Reform?

Dr. Andom: This is one of the largest projects we have at PIH Lesotho and in terms of impact, it’s the most prominent to the health system. Similarly, I feel this is one of PIH’s biggest contributions to the government of Lesotho.

Since 2006, PIH Lesotho has accompanied the Ministry of Health in providing primary health care services in the rural, hard to reach areas of Lesotho. In 2013, the former prime minister, Dr. Thomas Thabane, visited one of the PIH Rural Health Initiative sites, Bobete Health Center, and was impressed with the transformational impact. All indicators, including maternal mortality and HIV, were good. Also, the investment in equipment, such as ultrasound and x-rays machines, was unbelievable to see in those remote health facilities.

The government of Lesotho then asked: “Why doesn’t PIH help the Ministry of Health to replicate what it has done in those sites in other parts of the country?”

Next, the Ministry of Health and PIH Lesotho convened to strategize the best method to adapt the PIH model of care into the National Health Reform. To start, PIH Lesotho supported the Ministry of Health in conducting a baseline study which identified the gaps and barriers in Lesotho’s health system. The study included information from partners at the national level, all the way to the community level.

The study found clogged channels of communication within the national public sector, limited capacity at the district level, and insufficient strategies to effectively monitor the impact of village health workers.

In 2014, PIH Lesotho co-created a strategic plan with the Ministry of Health and began to implement the Health Reform in four pilot districts: Berea, Botha Buthe, Leribe, and Mohale’s Hoek. PIH Lesotho became the government’s primary technical advisor on its National Health Reform.

As part of the Health Reform, all health facilities under the pilot districts were managed by their respective district and under the leadership of a district manager. Once the office was identified, it was fully equipped with supplies and human resources. Fourteen positions were created in each district—ranging from a district health manager to public health nurse and technical support—to form the District Health Management Team (DHMT).

What is the current status of the Health Reform since its inception?

Dr. Andom: Back in 2017, an evaluation was conducted to understand the Health Reform’s impact on service delivery and the health system.

Dr. Ndayizigiye: Currently, the Health Reform model has been scaled up to the whole country. Each of the 10 districts of Lesotho has a DHMT responsible for implementation of Health Reform interventions at all levels of care. PIH Lesotho has further extended its support to the Ministry of Health by developing the now implemented Village Health Workers (VHW) Program Policy. With the Health Reform, the structure of the VHW program has been expanded and professionalized. VHWs and VHW Supervisors are creating impact at the community level; while VHW Coordinators placed in the health center, support VHW’s activities.

Through the DHMT’s supervision and leadership, health facilities have improved their capacity to provide integrated primary health care services. With this record of success, the government of Lesotho is now incorporating VHWs as formal personnel and increasing professional development opportunities to enhance their skill sets and service delivery.

In February 2022, PIH continued to support the Ministry of Health by training all senior management about transformational leadership. PIH Lesotho remains steadfast in its commitment to provide technical support and develop additional tools, policies and strategies, including mental health policies, emergency and critical care strategies, and cancer prevention strategies.

employees inside Bobete Health Center
Pharmacy Assistant Selete Selete shows Dr. Chiyembekezo Kachimanga, clinical manager for PIH in Malawi, the systems and tools used to manage the pharmacy at Bobete Health Center in June 2014, as part of a cross-site learning session. The center is one of the PIH Rural Initiative Sites in Lesotho. Photo by Jeanel Drake / Partners In Health

What impact has the COVID-19 pandemic had on the health reform facilities in the pilot districts?

Dr. Ndayizigiye: The COVID-19 pandemic has negatively affected health service delivery in the pilot districts and across the country. A lot of health care workers have been infected and some unfortunately lost their lives. Use of essential health services has decreased as a result of the pandemic. However, the DHMTs managed to organize COVID-19 infection control at all levels of care and rolled out COVID-19 vaccination in the districts. As result of the well-organized district health leadership, Lesotho has one of the highest COVID-19 vaccination rates among African countries.

After the evaluation, what were some of the most notable achievements for the National Health Reform?

Dr. Ndayizigiye: After the Health Reform evaluation, the Health Reform interventions have been scaled up across the country. New policies and strategies based on lessons learned from the pilot phase of the Health Reform have been developed, including the National Primary Health Care Strategy, National Strategic Health Plan, National VHW Program Policy, and Mental Health Policy. Most of those policies and strategies are being implemented. In addition to improving access to health services, new initiatives on health care quality improvement and continuous capacity building for health care workers have been implemented.

What are some of the challenges of the National Health Reform?

Dr. Ndayizigiye: I have just one sentence to summarize all of the challenges: we do not have enough funding to meet the increasing demand for health services at all levels of care.

What are you hoping the National Health Reform will achieve across the country in the next five years?

In the next five years, the Ministry of Health and PIH Lesotho hope that at least 90% of the country's citizens will have universal health coverage, and ultimately that everyone, everywhere in Lesotho will have access to high-quality, affordable health services. The National Health Reform program is integral to the steady progress in reaching universal health coverage goals. To adapt and address challenging health determinants and health conditions, PIH Lesotho will continue to accompany the Ministry of Health in its implementation of new and innovative interventions to strengthen Lesotho’s health system.

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