Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage

Abstract

In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.

Fig 1. Changes in quarterly average number of women attending prenatal and antenatal care visit Q3 2013 –Q2 2017.

a. shows the changes in quarterly average number of women attending prenatal care visits in four rural districts across Lesotho. b shows the changes in quarterly average number of women presenting for their first and fourth antenatal care visits in four rural districts across Lesotho. Both figures show the change over time beginning in the third quarter of 2013 (before the National Health Reform) through the second quarter of 2017 (nearly three years into the National Health Reform).

Fig 2. Percent of deliveries occurring in a hospital or health center in Lesotho.

Fig 2 shows the percentage of births occurring within health centers in four rural districts across Lesotho, comparing pre- and post-National Health Reform interventions.

Fig 3. Quarterly average number of children fully immunized at one year of life by district in Lesotho, Q3 2013 –Q2 2017.

Fig 3 shows the quarterly average number of children fully immunized at one year in each of four rural districts across Lesotho in which National Health Reform interventions took place, comparing pre- and post-intervention results. Notes: (Figure 19) [1] The pink line represents the line of best fit. The slope is 71.940 [2] Excludes hospitals.

Fig 4. Increased number of HIV tests at health facilities Q3 2013 –Q2 2017.

Fig 4 shows the trend in the number of HIV tests performed outside of the hospital across four rural districts in Lesotho over time, plotted against the targets for HIV testing established by the Universal Health Coverage goals. The figure shows the change over time beginning in the third quarter of 2013 (before the National Health Reform) through the fourth quarter of 2016 (more than two years into the National Health Reform).