‘Le­sotho tack­ling AIDS scourge‘

Lesotho Times - - Big Interview -

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, abut 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 to­geth- er 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.

Prime Min­is­ter’s Of­fice Prin­ci­pal Sec­re­tary Mothe­bathe Hlalele.

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