Un­sung he­roes of Le­sotho’s healthcare

Lesotho Times - - Feature - Bongiwe Zih­langu

THEY are the first point of care at com­mu­nity level, en­sur­ing HIV/AIDS and Tu­ber­cu­lo­sis (TB) pa­tients as well as preg­nant moth­ers, take their med­i­ca­tion and at­tend an­te­na­tal clin­ics regularly.

With­out them and their ded­i­ca­tion to sav­ing lives, there would be lit­tle TB and HIV/ AIDS re­sponse at com­mu­nity level.

Yet, Le­sotho’s Com­mu­nity Health Work­ers (CHWS) are a marginalised lot and hardly get the sup­port they de­serve to make their job eas­ier. Their measly M400 monthly al­lowances hardly come on time, and nei­ther do the ser­vice kits with­out which they can­not pro­vide the much-needed com­mu­nity-based healthcare. Mak­ing their job even more dif­fi­cult is the coun­try’s rugged ter­rain, par­tic­u­larly in the high­lands where vil­lages are hard to reach due to the poor con­di­tion of roads.

The plight of CHWS has been brought un­der the spotlight yet again—this time as a re­sult of the pend­ing launch of a pro­ject to be jointly run by the of­fices of His Majesty the King and the Prime Min­is­ter.

The ‘ No More Deaths in Le­sotho’ pro­ject, whose theme is ‘ Re­vi­tal­is­ing Pri­mary Health Care be­cause the life of ev­ery Mosotho mat­ters-for im­proved ma­ter­nal health, re­duced child mor­tal­ity and re­duc­tion of the scourge of Tu­ber­cu­lo­sis and HIV”, is sched­uled to be launched later this month, with King Letsie III and Prime Min­is­ter Pakalitha Mo­sisili lead­ing from the front.

His Majesty and Dr Mo­sisili would be en­gag­ing stake­hold­ers such as church-lead­ers, civic groups, the media, gov­ern­ment min­istries, de­vel­op­ment part­ners, chiefs, lo­cal coun­cils and dis­trict ad­min­is­tra­tors in their ef­forts to en­sure a healthy na­tion.

Vil­lage health work­ers have also been iden­ti­fied by the pro­ject’s di­rec­tors as crit­i­cal stake­hold­ers who need em­pow­er­ment to im­prove health ser­vices at grass­roots level.

Mamo­hau Makhata (55) of Pit­seng-lon­don in Leribe dis­trict, has been a CHW since 1992 and cur­rently cares for 36 pa­tients, most of them Hiv-pos­i­tive. Vil­lage health work­ers are se­lected by fel­low res­i­dents in the pres­ence of com­mu­nity lead­ers such as chiefs and su­per­vised by trained nurses.

The CHWS are given med­i­cal kits to help pa­tients at home. The kits, pro­cured with the sup­port of Global Fund grants, are dis­trib­uted by the Na­tional Drugs Ser­vices Or­gan­i­sa­tion.

Makhata says pro­vid­ing care for the pa­tients has not been an easy jour­ney, par­tic­u­larly due to lack of tools and the ever-present dan­ger of in­fec­tion.

“We don’t have gloves to han­dle pa­tients with, which puts most of us at risk of con­tract­ing dis­eases, par­tic­u­larly HIV. Even at clin­ics where we nor­mally ask for util­i­ties, they also don’t have gloves,” Makhata told the Le­sotho Times.

Med­i­ca­tion, which Makhata says forms part of the ser­vice kits, is also one of the ma­jor chal­lenges, she added.

“It be­comes even worse when you have to treat pa­tients just be­fore ac­com­pa­ny­ing them to a clinic or hos­pi­tal, but you don’t even have parac­eta­mol to give them,” Makhata said.

“We also are in dire need of toi­letries to clean our pa­tients with. Most of our pa­tients have ab­so­lutely noth­ing to their name.”

Makhata fur­ther says due to lack of ac­cess roads to vil­lages and the chal­leng­ing moun­tain­ous ter­rain, it is dif­fi­cult to get pa­tients to health cen­tres on time, adding the sit­u­a­tion is made worse by the mea­gre al­lowances they are paid “which also don’t come regularly”.

She con­tin­ued: “The ma­jor­ity of our pa­tients are poor and don’t have much. We have to dig dip into our pock­ets to pay for trans­port to get them to hos­pi­tal. There are cases where preg­nant women even give birth on the way to hos­pi­tal.”

Makhata fur­ther main­tains that of the 36 Hiv-pos­i­tive pa­tients in her care, the ma­jor­ity is bedrid­den or not strong enough to travel long dis­tances, hence her con­stant travel to the hos­pi­tal to col­lect their an­tiretro­vi­ral med­i­ca­tion.

On al­lowances, Makhata says she is paid M900 ev­ery three months, but is quick to add not ev­ery CHW gets the money.

“Some of the new work­ers are worse off be­cause un­like us who get M900 ev­ery three months, they go for months with­out be­ing paid any­thing. It is dif­fi­cult, very dif­fi­cult,” Makhata said.

Le­sotho has the sec­ond high­est rate of HIVin­fec­tion in the world be­hind Swaziland, with al­most one-quar­ter of the adult pop­u­la­tion es­ti­mated to be Hiv-pos­i­tive. Some stud­ies put the coun­try’s av­er­age life ex­pectancy at less than 40 years as a re­sult, while the steep moun­tains and harsh weather ex­ac­er­bate the sit­u­a­tion by mak­ing it hard to ac­cess health ser­vices for many peo­ple. Many pa­tients walk for an av­er­age of four hours over the bleak ter­rain to ac­cess healthcare, and by the time they reach clin­ics or hos­pi­tals, they con­di­tion would have be­come worse.

‘Mati­isetso Nto­baki (47) is also a vil­lage heath worker but based in Mphosong in Khoaba-la-e-ja-bo­hobe. She has been a CHW for al­most two years and mostly cares for preg­nant women and new moth­ers.

“I have been a vil­lage health worker since last year, and it has not been easy at all,” Nto­baki said.

“We don’t get our al­lowances on time and ser­vice kits are very scarce. This makes it dif­fi­cult for us to treat pa­tients.

“Even when the money fi­nally ar­rives, it is very lit­tle if one con­sid­ers the job we do. For in­stance, some­times we have to ac­com­pany preg­nant women to the hos­pi­tal at night and need to pay for trans­port. But be­cause the money won’t be there, we have no choice but to walk to the hos­pi­tal, thereby en­dan­ger­ing our lives.”

Both Makhata and Nto­baki are ap­peal­ing to gov­ern­ment to ease the bur­den of CHWS by pro­vid­ing them with the nec­es­sary equip­ment and their stipends on time.

“I ap­peal to gov­ern­ment to im­prove our work­ing en­vi­ron­ment be­cause we are com­mit­ted to car­ing for our peo­ple and sav­ing lives. We were promised al­lowances on a reg­u­lar ba­sis, monthly to be spe­cific. But they al­ways come late and when they do, they are never back­dated. We never get paid the whole amount,” Nto­baki says.

Makhata also urges gov­ern­ment to build roads in ev­ery part of the coun­try to ease move­ment and en­able them to reach health cen­tres timeously.

“We take pa­tients to clin­ics and hos­pi­tal on a daily ba­sis. We also go there to col­lect med­i­ca­tion for those who are not strong enough to travel, but with­out roads, this is ex­tremely dif­fi­cult,” Makhata said, adding gov­ern­ment should also en­sure clin­ics and hos­pi­tals are supplied with enough med­i­ca­tion.

Mean­while, Te­boho Phakoa, Di­rec­tor of Live and Safe Life As­so­ci­a­tion Ma­lut­ing—a non-gov­ern­men­tal or­gan­i­sa­tion based in Se­monkong—says the plight of CHWS is mov­ing.

Ac­cord­ing to Mr Phakoa, the bad ter­rain and in­ac­ces­si­ble roads make it dif­fi­cult for pa­tients to re­ceive med­i­cal at­ten­tion on time, adding half the time, they are nursed by un­trained vil­lage health work­ers.

Mr Phakoa has also lamented lack of med­i­cal equip­ment among the work­ers, as well as the mea­ger al­lowances.

He sug­gests for the CHWS to get the recog­ni­tion they de­serve, im­ple­ment­ing bod­ies such as the Le­sotho Coun­cil for Non-gov­ern­men­tal Or­gan­i­sa­tions (LCN) and Le­sotho Net­work of Peo­ple Liv­ing with AIDS should en­sure funds from donors “reach their right­ful ben­e­fi­cia­ries”.

“If peo­ple are go­ing to do their jobs ef­fec­tively, ben­e­fi­cia­ries need to get their monies di­rectly be­cause im­ple­ment­ing bod­ies al­ways fail to en­sure this hap­pens,” Mr Phakoa said.

“Only a small amount of donor funds reaches ben­e­fi­cia­ries, which cre­ates a host of chal­lenges at grass­roots level.”

Mr Phakoa has urged donors to en­gage con­sul­tants to en­sure the funds are dis­bursed on time.

“Donors must en­gage con­sul­tants to work di­rectly with grass­roots or­ga­ni­za­tions be­cause mother-bod­ies de­lay in en­sur­ing the monies reach the grass­roots,” Mr Phakoa says.

Thakane Kotelo, the Ex­ec­u­tive Di­rec­tor of Phe­lisanang Boph­e­long—an NGO based in Leribe—also said CHWS do not get the re­spect they de­serve.

“They don’t get paid, yet these are the same peo­ple who fill the gaps left by the Min­istry of Health. With­out them, there would be no HIV and TB re­sponse,” Ms Kotelo says.

“These are peo­ple who are on the ground, pro­vid­ing ser­vices at com­mu­nity level.”

Fail­ure by the health min­istry to recog­nise CHWS, Ms. Kotelo adds, is due be­cause it “re­lies on its own struc­ture”.

“The min­istry does not recog­nise civic groups, yet we are their watch­dogs, al­ways mak­ing noise and en­sur­ing gov­ern­ment poli­cies are im­ple­mented. We don’t even ask for credit be­cause we have a role to play. When we ar­rive at vil­lages, we ap­proach the min­istry and ask what gaps we can fill to as­sist and how best we can in­cor­po­rate our chal­lenges. But there is no co­or­di­na­tion or re­la­tion­ship be­tween the min­istry and civic groups,” she said.

The min­istry, she added, should start to se­ri­ously en­gage com­mu­nity health work­ers be­cause “we’re work­ing within the Na­tional De­vel­op­ment Plan”.

Ms Kotelo fur­ther says she ap­plauds the Pri­mary Health Care Re­vi­tal­i­sa­tion Pro­ject and its fo­cus on in­vest­ing in “in­di­vid­u­als, in­sti­tu­tions and ac­tions that cre­ate an en­vi­ron­ment for the speedy de­liv­ery of health ser­vices”.

“If the pro­ject takes off, vil­lage health work­ers are go­ing to ben­e­fit im­mensely. Here we are talk­ing about in­vest­ing in peo­ple and in­sti­tu­tions that speed the de­liv­ery of health ser­vices. I en­cour­age this com­mu­nity-led ap­proach; ser­vices need to be de­cen­talised and lo­cal gov­ern­ment is that gate­way to ser­vices com­ing to the com­mu­nity.”

Part­ners-in-health Le­sotho Di­rec­tor, Dr Garry Got­tlieb, has also high­lighted the im­por­tance of CHW, say­ing they are vi­tal be­cause they “pro­vide in­te­grated com­mu­ni­ty­based care”.

Part­ners-in-health (PIH) is one of the or­gan­i­sa­tions at the fore­front of the PHC re­vi­tal­iza­tion pro­ject and has al­ready in­vested heav­ily in CHW.

Pih/le­sotho was launched in 2006 at the in­vi­ta­tion of the Le­sotho gov­ern­ment and in con­sul­ta­tion with the Clin­ton Health Ac­cess Ini­tia­tive. The or­gan­i­sa­tion is work­ing to im­prove the health of eight re­mote com­mu­ni­ties, pro­vid­ing in­te­grated ser­vices for ma­ter­nal and child health, HIV, and tu­ber­cu­lo­sis, while man­ag­ing the na­tional pro­gram to treat mul­tidrug-re­sis­tant tu­ber­cu­lo­sis (MDR-TB). The pro­gramme brings healthcare to nearly 200000 peo­ple.

Con­tacted for com­ment, the Min­istry of Health In­for­ma­tion Of­fi­cer Mate­boho Mose­bekoa re­ferred the Le­sotho Times to the Di­rec­tor-gen­eral Health Ser­vices, Dr Nnyane Letsie.

How­ever, both Dr Letsie and Health Min­is­ter Dr ‘Molotsi Monya­mane were not read­ily avail­able.

Dr Letsie’s mo­bile phone rang unan­swered yesterday, while sev­eral at­tempts to con­tact Dr Monya­mane also proved fu­tile as he was said to be in a meet­ing.

At­tempts to reach the min­is­ter later in the day proved fruit­less as his phone was now on voice­mail.

A group of women sing out­side the Bo­bete Health Clinic in Le­sotho. (Pic by An­drew Marx)

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