The acute shortage of doctors and drug supplies in Lesotho continues to affect the ability of clinics to provide comprehensive primary healthcare, which is crucial for preventing illnesses before they escalate.
This crisis was exposed this week when parliament’s social cluster committee undertook an inspection tour of different health centres in the capital Maseru. The exercise saw the committee visiting eight clinics and one hospital.
According to a 2022 International Organisation for Migration report, the health personnel to population ratio in Lesotho is severely compromised, with five physicians and 62 nurses per 100,000 people.
This acute shortage of skilled health professionals has negatively affected health care in Lesotho.
While the World Health Organisation recommends a ratio of one doctor for every 1,000 patients as a benchmark for adequate healthcare coverage, the rough estimation of doctor to patient ratio in Lesotho is approximately one doctor for every 3,600 patients.
Last week’s visitation was also done to inspect medical equipment and supplies, and to seek whether they are available and if they are used the right way.
According to committee chairperson Mokhothu Makhalanyane, the inspection revealed that clinics are not manned by medical doctors, but are instead often staffed with registered nurses or nurse assistants who may not have the expertise to handle certain medical conditions that doctors traditionally manage.
Makhalanyane said the committee also learnt that for a clinic to function effectively and provide comprehensive healthcare services, it requires a well-rounded team of healthcare professionals including doctors, nurses, and pharmacists
The committee also scrutinised structures to check if buildings were intact, that there was no water leakage, and that sanitation and hygiene were in order. It further checked the records of the health facilities.
“The committee established that, apart from doctors, there was also a dearth of pharmacy technicians while the clinics had run out of drug supplies.
“The site visits uncovered issues with infrastructure maintenance, medical equipment, and availability of medical supplies,” he noted.
The visit also uncovered that some clinics are not properly regulated or supported by the ministry of health, leading to inconsistencies in service delivery.
Also, the challenge of inadequate staffing is rampant. For example, the Ha Thamae and Khubetsoana clinics do not have doctors and pharmacy technicians; they are also experiencing an acute shortage of medication, Makhalanyane said.
He explained that the two clinics are the responsibility of the Maseru City Council, and the committee’s conclusion was that they are not properly regulated by the ministry of health.
“We are pushing for clinics’ medicine supply to fall under the supply chain. And, as for maintenance works, they should fall under a structure we have established called Project Implementation Unit of the ministry of health.
“To remedy all clinics’ challenges, we think there should be doctors deployed, who visit the clinics on certain days. There are many vacancies that doctors are willing to fill but, unfortunately, they are put off by working conditions; they feel there aren’t enough benefits for them,” he pointed out.
In another development, the president of the Lesotho Medical Association, Dr Mojakisane Ramafikeng, admitted that there is a shortage of doctors in Lesotho.
In an interview with theReporter this week, Dr Ramafikeng said there are about 540 doctors including dentists in the whole country, way short of the ideal 2,200.
He indicated that clinics serve a vital role in primary health care, which emphasizes preventive measures aimed at promoting health and well-being, rather than just treating illnesses. These preventive measures include vaccinations, health screenings, health education, and early intervention strategies.
Dr Ramafikeng also conceded that the shortage of doctors in clinics significantly affects their ability to provide comprehensive primary health care.
“Doctors play a crucial role in preventive care by conducting screenings, diagnosing health conditions early, and prescribing appropriate treatments or interventions to prevent illnesses from progressing.
“The imbalance between the number of doctors and patients means that clinics may struggle to meet the healthcare needs of their communities effectively.
“A lower ratio of doctors to patients can lead to longer waiting times for appointments, reduced time for patient consultations, and challenges in managing chronic conditions,” he said.
He added that although nurses are capable of handling medication administration, having dedicated pharmacy technicians ensures that medication management processes are handled efficiently, safely, and accurately.
Dr Ramafikeng further suggested that efforts should be made to recruit and retain more doctors and other healthcare professionals in clinics, particularly in underserved areas.
“One solution could be for such positions to be at clinics, and this should not only be a responsibility of the ministry of health, but of public service as well.”
He went on to indicate that South African universities have historically partnered with the government of Lesotho to train and educate healthcare professionals, particularly doctors.
“The National Manpower Development Secretariat played a role in supporting students pursuing medical qualifications. Specifically, students with a background in medicine were encouraged to pursue their education without the burden of financial debt.
“In the long run, there is a desire to establish local medical institutions to address the country’s dependency on entities for healthcare capacity building,” Dr Ramafikeng concluded.
Meanwhile, The Pharmacy Association of Lesotho (PAL) has previously warned that government’s reluctance to employ qualified professionals such as pharmacy technicians in its health centres could have serious implications on the health of patients.
While a pharmacist is a health care professional who is specifically trained to store, handle, prepare and dispense various medications, pharmacy technicians are trained in the technical aspects of supplying medicines and medical devices to patients under the supervision of a pharmacist.
PAL noted that in the absence of qualified pharmacists, the responsibility to dispense drugs is left to health personnel.
It emphasized that poor handling of medication by untrained persons could have far-reaching implications that might put patients’ lives at risk, especially the more vulnerable ones.
The association went on to warn that medicines themselves can be unsafe if not handled properly; they can cause disability, drug resistance (especially anti-microbial) if the course of medication is not completed or if it is not an optimal dose.
Presenting the 2024/2025 budget speech earlier this year, the minister of finance and development planning, Retṧelisitsoe Matlanyane, made no mention of the ministry of health’s plans to address the acute shortage of doctors and pharmacists in the country, Matlanyane only hinted that the Millennium Corporate Compact II will provide US$75 million (about M1,5 billion) over a five-year period to improve health outcomes through strengthening Lesotho’s primary health care improvement of primary health services.
