Lesotho rural health development project : final report, January 1979-May 1984

The project was remarkably successful in establishing PHC as a high GOL priority and in extending PHC to underserved communities. Efforts focused on two areas - strengthening planning and management support for PHC delivery and training nurse clinicians (NC"s) and village health workers (VHW"s). In the first area, the Ministry of Health (MOH) decentralized financial, personnel, and health information management to the district and local levels by mid-1983, and the drug supply system is working well. Several problems remain, however: only half of the health centers have two-way radios; many of the vehicles donated by MOH are in need of repair and maintenance; and the general supply system, despite attempts to strengthen and decentralize it, requires immediate attention. Training activities proved very effective. The targeted number of NC"s (55) were trained and various GOL ministries combined efforts to train 2,000 VHW"s against a target of only 300. An effective Basotho staff developed and assumed primary responsibility for training during the project"s final year. In addition, the Nurse Clinician Training Center instituted a continuing education program for NC"s and VHW"s, with monthly supervision, a bi-monthly newsletter, and an annual conference for NC"s. A comprehensive set of training materials based on MEDEX"s prototype PHC series was adapted to Lesotho; VHW workbooks were written in both Sesotho and English and were tested and distributed throughout the country. Two operations manuals were produced for health center and district-level management personnel. The most critical problem at present is the need to establish a career structure for NC"s and for health administrators. Personnel problems with NC"s (low morale, attrition, and recruiting difficulties) were eased after the GOL raised NC salaries to an acceptable level. Raising the salaries of health administrators would ease similar problems. Nonetheless, the project provides a model of what might be accomplished in similar situations.