Evaluation of Lesotho rural health development project

Special evaluation covers the period 3/79-2/80 and is based on site visits and interviews with MOH personnel. The MOH"s plan to provide PHC using nurse clinicians (NC) and village health workers (VHW) has proved to be sound. The MOH"s currently understaffed Planning Unit was assisted in: drafting a national PHC program, promoting other donor programs, renovating rural clinics, forming a statistics sub-unit, holding management and curriculum adaption seminars, conducting long-range planning, and preparing legislative proposals. Also, 10 administrators have returned from training in Botswana; MOH/private sector cooperation has improved; a plan and schedule to decentralize the MOH have been adopted; and 17 Health Service Areas have been designated as centers for PHC activities and administration. Although a pharmaceutical production/storage/distribution system was set up, administrative problems (e.g., with accounting and supplies) have arisen at the Health Service Area level. To prepare for the NC training program, enabling legislation was passed and procedures/policies were formulated. VHW"s are being trained in 12 hospitals, and MEDEX modules are being adapted to Lesotho"s specific needs for both NC and VHW training. To replace those enrolling in the NC program, 161 nurse assistants (NA) were or are being trained. The evaluators favor proceeding with Phase II, but because of existing problems (inadequate maintenance, poor radio communications, high staff turnover, and sub-optimal control over PHC providers) recommend that the MOH: (1) seek budget increases to purchase equipment/vehicles and to provide incentives needed to attract and retain competent medical and support personnel; (2) revise participant training objectives; (3) reconsider disallowing trained nurses from receiving NC training; (4) review the future role of NA training; (5) better train dispensary personnel; (6) upgrade logistic and administrative support to Health Service Areas; (7) assess its data requirements; and (8) set up a vehicle repair shop.