GOVERNMENT is planning to establish the Lesotho HIV and AIDS Authority (LeHA) to coordinate programmes aimed at eradicating the HIV/AIDS epidemic, which continues to plunder the country’s populace. LeHA would fall under the Prime Minister’s Office and replace the National AIDS Commission (NAC), which was disbanded in November 2011 following a damning report that it had become a burden to taxpayers.
The Prime Minister’s Office Principal Secretary, Mothebathe Hlalele, talks to Lesotho Times (LT) reporter, Lekhetho Ntsukunyane, about LeHA in this wide-ranging interview.
LT: Some stakeholders believe NAC’s dissolution is partly to blame for Lesotho’s failure to contain the spread of HIV, whose 23 percent prevalence rate makes it the second-highest in the world behind Swaziland. Before NAC was disbanded, the country’s HIV-prevalence was third behind Swaziland and Botswana respectively, although it was still 23 percent. Could the establishment of LeHA be in direct response to this unenviable record?
Hlalele: Sometime in 2014, cabinet approved the establishment of a new HIV and AIDS coordinating body to replace the now-defunct National AIDS Commission. Government was aware and concerned about the escalating negative effects of the AIDS pandemic in our country, and also the fact that Lesotho’s HIV-prevalence rate was now second in the world, behind Swaziland (at 26 percent). This, indeed, is a very worrying situation, hence government, with the assistance of UNAID (United Nations Programme on HIV and AIDS), decided to establish the body, whose primary mandate shall be to coordinate and regulate all response efforts against HIV and AIDS in Lesotho.
LT: But what really went wrong with NAC?
Hlalele: NAC was established by government in 2005 to coordinate the already existing but diverse and fragmented national efforts to fight HIV and AIDS. The organisation was established as an independent body and accounted to government through the Office of the Prime Minister. However, a study undertaken by Deloitte & Touché Auditors (of South Africa), which was commissioned by government to evaluate NAC’s performance vis-à-vis its administrative costs, found out that the organization had become a burden to taxpayers. The Deloitte audit also revealed that the Commission had deviated from its core mandate of coordinating and delved into implementation, which blurred the line of separation of responsibilities and duties with the Ministry of Health and other stakeholders. Deloitte further found out that as a result of this deviation, the secretariat had become so big and too costly for government, with less and less output in the coordination of the national response to HIV and AIDS.
Government then decided to disband it and establish a more focused, efficient and effective coordinating body, with clearly defined functional parameters and regulatory authority to ensure accountability. The findings were that NAC failed to make progress because government was not directly participating in its day-to-day operations and administration. Because the commission was not directly accountable to government, it now appeared to the international community as if it had no interest at all in coordinating HIV and AIDS issues. And again, because it was not directly accountable to government, NAC had lost direction.
LT: How then did the government come up with LeHA?
Hlalele: I only occupied this office in January this year, but as I have already mentioned, government had made a resolution to replace NAC. What I only did was put together a team of officials from the Office of the Prime Minister, and come up with a concept road-mapping a clear target of what the government wanted to achieve in dealing with HIV and AIDS.
It was clear this body had to be different from NAC, and our model was so much welcomed by UNAID that will be funding this initiative once it becomes functional.
LT: How exactly will LeHA operate?
Hlalele: Like I said, the authority will control the harmonisation and alignment of the national response to HIV and AIDS. It shall be responsible for designing and coordinating high-impact intervention that will contribute to the reduction and ultimately, total eradication of HIV and AIDS in Lesotho. The authority shall be accountable to the government, through the Office of the Prime Minister, and ultimately to parliament.
LT: Could you tell us about its structure?
Hlalele: There will be a Board of Directors, as well as various committees on prevention, treatment, care, mitigation, coordination, regulation and other specialized areas. In our concept paper, we proposed that Board members, unlike in other institutions where they receive sitting allowances, be paid monthly allowances so that they are available anytime they are needed. This idea also has been gladly welcomed by UNAID. The secretariat, on the other hand, will comprise a Chief Executive Officer (CEO), Director-Strategic Programmes, Coordination Manager, Resources Manager, Regulation Manager, Manager-Monitoring and Evaluation, Advocacy Manager and other senior officials. The recruitment of the CEO will be done by UNAID officials who will conduct final interviews to determine the right candidate. This is because we want LeHA to be as apolitical as possible. As government, we will only invite applications for the post. We are serious about tackling this epidemic and getting rid of the embarrassment Lesotho faces due to its high HIV-prevalence rate. In fact, we have already published an advert concerning some of these positions, and received a few responses. However, we are hoping to run the advert again to give more people the chance to submit their applications. We are actually looking for a broader spectrum in the structure which should include people with a good background on legal, financial, medical and general administration issues, among other qualifications.
LT: When do you hope to complete this exercise and have the Authority up and running?
Hlalele: It will depend on government’s will to drive this project as fast as possible. And because of the current transition of government, we don’t know exactly what will happen in this office. Things might change and people might come with a different concept. So at the moment, we cannot really say when LeHA will be fully functional.
LT: How serious is the HIV and AIDS scourge in Lesotho, notwithstanding the prevalence?
Hlalele: Since its declaration as a national disaster by His Majesty King Letsie III in 2000, AIDS continues to be one of the most disturbing and significant challenges to sustainable economic and social development in Lesotho. And most critically, the disease has become a real threat to the survival of Lesotho as a nation and the country’s achievement of economic growth and development. Lesotho remains among the countries with the highest HIV incidences and prevalence in SADC (Southern African Development Community) and currently ranking at number two in the world. Furthermore, poverty and food insecurity have been identified as additional new drivers of the epidemic, complementing multiple concurrent sexual partnerships, inter-generational sex and early sex. The purpose of establishing LeHA is to strengthen the leadership, management and coordination of the multisectoral national response to this disease.
Lack of effective and efficient coordination of the national multisectoral HIV and AIDS response has contributed to the fragmentation of the response, duplication of efforts, increased costs of service-delivery, and more importantly, inadequate utilisation of services, especially to the population groups that are most at risk, while on the other hand, Basotho continue to suffer and die from AIDS-related complications. At the moment, there is no single institution charged with the oversight responsibility, which can be held accountable for the expected results in order to ensure a positive impact. Consequently, the absence of an effective national coordinating body has also compromised the use of strategic information and data to inform policy decisions on the HIV and AIDS response. This also impedes the leveraging of additional resources and technical assistance for the response, including the adequate transfer of skills and knowledge.