The Lesotho Implementation Capacity Assessment, carried out by EQUIP for the country’s Ministry of Health, shows that significant progress can be made towards its 90-90-90 Test and Start goals by strengthening facility-level information systems, stock control, training of health care workers and management of viral load testing.

“We see numerous opportunities for strengthening existing systems in Lesotho’s health facilities that will allow them to manage growing patient numbers over the next few years,” said Miranda Moloto, Technical Specialist (Care & Treatment) of EQUIP Central.

Key points and Recommendations

Lesotho Ministry of Health Implementation Action Plan

  • The Lesotho Ministry of Health (MoH) introduced the Test and Treat policy in 2016.
  • EQUIP carried out an Implementation Capacity Assessment to identify health facilities that required support to manage the growth in patient numbers.
  • To keep pace with the growing number of people on ART in Lesotho, EQUIP developed an implementation action plan for the MoH to upgrade stock control systems and storage for medicines.
  • As recommended by EQUIP, Lesotho MoH is in the process of engaging its partners to implement an electronic information management system, which will support record keeping for patient and pharmacy data.
  • Lesotho MoH has been advised to develop Standard Operating Systems (SOPs) for consistent record-keeping that enable faster turnaround of viral load test results, and assists in reducing antiretroviral treatment failure. While the MoH is responsible for development of SOPS, EQUIP is keeping in regular contact to provide support as needed.

In September 2016, eighty-five (85) health facilities providing antiretroviral therapy (ART) were chosen to represent a cross-section of Lesotho’s health sector, taking part in an Implementation Capacity Assessment of the country’s Test and Start program. The assessment was conducted by EQUIP on behalf of the Lesotho Ministry of Health.  

In Lesotho EQUIP and in-country partner Right to Care, focus on roll-out support of the Test and Start program.

Lesotho was the first country in Africa to adopt the Test and Start program, with provision of ART to everyone at diagnosis, regardless of CD4 count. It was established that approximately 36% of people living with HIV in Lesotho are currently receiving ART.

“Our assessment looked for bottlenecks that might slow down implementation of the Test and Start program, and identified existing infrastructure and capacity that could help in the rapid scale up of the program,” Philip Mwala, Regional Technical Specialist of EQUIP Central.

Rolling out the Test and Start program in Lesotho will result in a big increase in the number of people on treatment, as well as the number of laboratory tests carried out. However, the assessment found that facilities lacked storage space for the anticipated increase in medicines and laboratory commodities.

“We found that thirty-two percent of facilities were forced to store medicines on the floor due to lack of space,” noted Molaudi Gaula, Regional Pharmaceutical Services Manager of EQUIP Central.

EQUIP has recommended a comprehensive supply chain management training program to the Lesotho Ministry of Health. This includes development of Standard Operating Procedures (SOPS) and data collection tools for facility-level demand planning and forecasting, which will support full implementation of the Test and Start program, with a focus on multi-month scripting and dispensing (MMSD).

Monitoring the progress of Test and Start will also require good-quality data on patients, medicines and commodities.

“We found that facilities with an electronic information management system, or which had a staff member responsible for records, had better quality data than those without,” Mwala said.

EQUIP has recommended the roll out of an electronic system for data entry to all facilities in order to assist with capturing patient and pharmacy data. Appointing a Records Officer for each facility could also improve data management.

The assessment also identified potential gains in HIV testing and viral load testing. More targeted offers of testing could increase the yield of testing. Procedures for consistent record-keeping and faster turnaround of viral load results will also improve the ability of health facilities to address the needs of patients failing on ART.

“We hope this research will allow Lesotho to move rapidly and identify innovative solutions that will strengthen the country’s health system,” Mwala concluded.