Slow improvement in public health sector

MASERU-A WORLD Bank report on Lesotho’s public health sector for 2017 says there has been a slow improvement in health outcomes around the country. The Lesotho Public Health Sector Expenditure Review 2017 was released in Maseru yesterday.

The review shows that maternal and neonatal mortality rates in Lesotho are among the highest in the world with 1 024 deaths per 100 000 and 59 per 1 000 respectively. The findings also reveal that Lesotho’s health system looks very fragmented with several pools of resources from donors and government and different service providers operating according to different priorities and operating mechanisms without any accountability.

The data for the Ministry of Health expenditure on outsourced health services reveal that over the past four years, the ministry’s public-private-partnership with Tšepong (Queen ’Mamohato Memorial Hospital) has accounted for approximately 30 percent of the total ministry’s recurrent expenditure.

And this proportion has been stable. The findings further reveal that Tšepong and the associated clinics have provided healthcare services to between a third and half of all the inpatients in Lesotho each year and have been treating a quarter of the country’s outpatients. Meanwhile, the findings show that payments for the Christian Council of Lesotho (CHAL) have increased by 121 percent.

“Large nominal expenditure increases of more than 100 percent were seen for District Health Management Teams (DHMTs), 135 percent, laboratories 126 percent, planning 163 percent and pharmaceuticals 162 percent,” the review, which was released yesterday, says. This is in line with the nominal increase seen for government-run DHMTs which are responsible for delivering primary healthcare services and managing primary health care centres across 10 districts, the report adds.

It says the administration cost centre which includes Tšepong spent 99 percent of its budget each year over the period studied.

It adds that district hospitals performed below this amount in terms of their absorptive capacity with an average budget use of about 90 percent. “This average belies significant differences in the performance of district hospitals with Mafeteng Hospital consistently using about 95 percent of its budget while Machabeng Hospital used less than 70 percent of its budget,” the findings show.

Machabeng Hospital used only 63 percent in the Fiscal Year 2015/16. In terms of absorptive capacity, the findings indicate that DHMTs performed worse than district hospitals, consistently struggling to spend their total allocated funding and averaging an utilisation rate percentage in the low-to-mid-80s.

The Leribe DHMT was the best performer, spending 97 percent of its budget in the Fiscal Year 2015/16 while Qacha’s Neck was the worst, at 61 percent the same year.

In view of the findings, it was recommended that in each health facility, staffing should depend on services provided, patient demand, and workload, and not to be fixed according to rigid input-based norms.

“Some thought should be given to the redeployment of health workers across Lesotho which currently seems unbalanced, for example, primary health centres seem understaffed, while some hospitals have excess staff given their load,” it said.

“It emerged that Maseru has the highest concentration of doctors and specialists whereas some other districts lack doctors,” it says. It is also recommended that there is a dire need to revise the CHAL Memorandum of Understanding to ensure greater accountability and oversight of funds and health outcomes.

The Review found that the current agreement with CHAL involves a lump-sum payment that it applies across the entire organisation, and the government has little control over how the funding is allocated.

It is further recommended that there should be a change for the payment system for hospitals and provision for greater autonomy in the day-to-day management of individual hospital facilities.

Another recommendation is that allocations to individual hospitals should be based on some measure of the service delivered by the same health facilities, and not input based norms.

Majara Molupe