Rural health development

Final PES covers the period 4/82-7/85 and is based on document review, site visits, and extensive interviews with NC"s, VHW"s, and other project personnel. Project outputs for the training component, which included establishing the training program using Basotho personnel and training 55 NC"s and 300 VHW"s over the life of the project, were all met or exceeded. NC trainers, who themselves have been practicing NC"s, provided adequate training, and NC"s are playing a vital role in extending community health coverage and improving patient care at local health centers (HC"s). VHW"s were adequately trained for their work by the NC"s; their principal duties include motivating mothers to attend maternal child care clinics, promoting safe water and sanitation activities, and health education. Through the VHW"s, health care has been successfully extended to the individual household level. The infrastructure support component was successful as well. Financial and personnel management were decentralized, as were data collection functions. The drug supply system was improved, and a two way radio communication system was installed and is functioning. Lesotho"s PHC system faces several chronic problems, however. One is a lack of personnel. While the NC"s are performing well, the typical HC is severely understaffed, and many PHC activities simply cannot be performed. The same is true for VHW"s, who often are forced to travel considerable distances to extend coverage to all parts of their assigned areas. Other problems stem from the lack of credibility VHW"s have in the villages, due in part to their isolation from the MOH infrastructure and to their inability to perform basic curative tasks. The NC"s themselves fit into no existing career structure within the MOH, despite the work they do. Finally, lack of transportation has proven a continuing problem for NC"s and VHW"s alike. The project displayed unusual sustainability characteristics, principally because of its clear focus and the Government of Lesotho"s (GOL) involvement in implementation. All GOL contributions were made as required and in a timely fashion. Recommendations for further improving PHC in Lesotho focus on the need to increase staffing levels, improve transport capabilities, screen NC candidates, and take steps to improve VHW credibility in villages and increase NC supervision of VHW"s.