Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage

Abstract

In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.

Effects of primary healthcare reform on routine health information systems (RHISs): a mixed-methods study in Lesotho

“…In a recent LPHCR study conducted by Ndayizigiye et al, the authors found that the quarterly average number of women who attended their first ANC visit rose from 1877 (SD ±263) pre-LPHCR to 2729 (SD ±287) in the last year of the intervention (LPHCR/TT). 15 Observed data completion improvement during the LPHCR/TT period and during the LPHCR highlights the synergy between different national-level initiatives aimed at improving population health outcomes. Mixed-effects regression analysis showed that the association was not confounded by health facility type and differences by district.…”

“…[12][13][14] Lesotho was behind on key millennium development goals aimed at improvement of maternal and child health outcomes. 15 To address gaps and to strengthen primary care, the Government of Lesotho, in partnership with Partners In Health, launched the first phase of the Lesotho National Primary Health Care Reform (LPHCR)-a pilot-in April 2014, in four districts: Berea, Leribe, Butha Buthe and Mohale's Hoek. 15 The three main objectives of the LPHCR were to improve service delivery, strengthen health system management and empower professional village health workers.…”

“… 15 To address gaps and to strengthen primary care, the Government of Lesotho, in partnership with Partners In Health, launched the first phase of the Lesotho National Primary Health Care Reform (LPHCR)—a pilot—in April 2014, in four districts: Berea, Leribe, Butha Buthe and Mohale’s Hoek. 15 The three main objectives of the LPHCR were to improve service delivery, strengthen health system management and empower professional village health workers. As a central input to chart progress, the Ministry of Health (MoH) enhanced the RHISs to map disease burden and to define and monitor progress against the United Nations Sustainable Development Goals of 2030—including achieving universal health coverage.…”

Awareness, treatment, and control among adults living with arterial hypertension or diabetes mellitus in two rural districts in Lesotho

“…Lesotho has a population just over 2 million and is classi ed as a lower-middle-income country 16 . Health services have traditionally been geared towards the control of infectious diseases and infant and maternal mortality [17][18][19] . Despite a signi cant prevalence of hypertension and diabetes in the country 20 , up-to-date data about awareness, treatment and control of hypertension and diabetes is scarcely available and is not routinely used to guide programmatic interventions.…”