By Relebohile Senyane
The last article focused on Lesotho’s efforts to realise the Millennium Development Goal on child and maternal health and the results of these interventions.
The paper identified five problem areas where interventions can massively impact on child and maternal health.
The identified setback is that of a persistent lack of drugs at public health care centres.
This is not solely due to diversion of drugs into the private health sector, although it is part of the problem.
The proposal goes to the Directorate of Corruption and Economic Offences (DCEO) to take up this issue through a public education and prevention programme, hopefully financed by donors such as Irish Aid and the European Union that have supported governance capacity improvements in Lesotho.
In implementing the project, the DCEO should work together with the Lesotho Medical Association, civil society, including community-based organisations, the Church Health Association in Lesotho, local government structures, the police, Ministry of Health and Social Welfare and other relevant institutions and users, through multi-stakeholder platforms.
The focus of such a project should include formation of long-term national and local multi-stakeholder platforms to monitor and prevent leakages in the medicine supply chain.
National education campaign to build awareness of the impact of drug theft on the health system must also be incorporated into such a project.
Labelling and identification of public health drugs must be improved.
Furthermore, reporting mechanisms and response systems at local and national levels must be up to standard.
However, for the project to be successful, the DCEO must be immune to political interference and be given enough power and support to investigate, summon, and prosecute suspects.
The second measure aimed at addressing the persistent lack of drugs in the public health centre includes the Ministry of Health and Social Welfare working directly with users and other stakeholders to enhance transparency of the medicine supply chain, from procurement, medical stores, to transfers of medicine to districts and local health centres.
In Uganda, the Coalition for Health Promotion and Social Development has campaigned for the inclusion of civil society organisations and user representatives on the board of the National Medical Stores.
The intervention in Lesotho might take a different form but it is important to facilitate broad consultations and discussions with stakeholders on a more transparent and inclusive drugs monitoring system.
The third and final intervention, also meant at addressing the persistent lack of medicine, requires health budget monitoring and tracking by civil society organisations.
In 2001, the African Union committed through the Abuja Declaration to allocate 15 percent of national budgets to improve the health sector.
The declaration was made in recognition of the threat posed by high rate of TB, HIV and Aids to health services.
In 2008/09, 10.3 percent of the budget was allocated to the Ministry of health and social welfare.
Given the other pressing needs this is a fair allocation.
However, an analysis need to be done to understand the share allocated to the procurement of drugs and whether this is improving or deteriorating; to monitor whether the health budget itself is growing in terms of progressive realisation of the right to health, and tracking of resources to monitor whether the allocated resources are reaching intended beneficiaries.
It is likely that future growth in the health and social welfare budget will reflect government commitment to Netcare as part of the Public Private Investment Partnership agreement signed for management of the Queen ’Mamohato Memorial Hospital and not necessarily increasing allocations to the overall health sector.
The second proposal is on the issue of continued stunting among children in Lesotho, which points to among others, a hunger problem.
According to a World Bank report on nutrition in Lesotho, 42 percent of children under five are stunted.
“This has been associated with impaired cognitive development.” Its effects are long term and impact on national development.
As a result of the low levels of agricultural participation, food insecurity in Lesotho is now closely associated with the ability to pay and is only a seasonal problem for some population groups.
While the government has put in place some interventions to support “orphans and vulnerable children” the continued high levels of food insecurity, manifested in the high incidence of stunting, underweight, low birth weight and wastage, suggests that the programmes are either not providing sufficient support or the threshold is too high.
A number of children who could benefit are not participating in the programmes.
The proposal is for social protection programmes aimed at children to move in the direction of accommodating a higher proportion of poor children, including lowering the threshold for participation and a gradual move towards a universal means tested social security programme.
In addition, the Ministry of Health and Social Welfare should work together with the Disaster Management Authority, local governments and civil society to establish village level emergency structures that will identify potential cases of hunger and respond early.
Additional and long-term mechanisms can include private public partnerships to build food banks, better nutrition education programmes and facilitating local food production through better structured agriculture support programmes.
Finally, policy-makers in the Ministry of Health and Social Welfare need to consider that a child social security programme with universal coverage might be cheaper and administratively less taxing than a limited programme which is prone to corruption and false claims.