Non-communicable disease management in the public health system of Lesotho

Abstract

The general aim of the study was to investigate and propose a model for the optimal disease management of non-communicable diseases (NCDs) in the public health system of Lesotho. To achieve this general aim, specific aims were formulated: (i) to assess the public health system in Lesotho in terms of health service delivery to patients with hypertension, diabetes mellitus, asthma and epilepsy in different healthcare facilities; (ii) to assess the role of the pharmacist in the national, district and primary healthcare (PHC) levels in the health system of Lesotho concerning the management of hypertension, diabetes mellitus, asthma, and epilepsy, and to (iii) develop a potential non-communicable disease (NCD) management structure emphasising the role of the pharmacist in hypertension, diabetes mellitus, asthma and epilepsy management in Lesotho. To attain the aims for the study, a literature review about chronic disease management models and the health system of Lesotho was performed, followed by an empirical investigation into the human resources, medication and medical devices, health management and information system (HMIS), healthcare financing, health infrastructure and equipment, and role of the pharmacist at the national, district and PHC levels of Lesotho’s public health system using self-administered structured questionnaires. The study followed a cross-sectional design. The study population included all employees in managerial positions and/or those in acting managerial positions at the Pharmaceutical Directorate, NCD unit, District Health Management Teams (DHMTs), outpatient departments (OPDs) in district hospitals, and the healthcare centres involved in the management of NCDs during the study period. Data were collected from December 2018 to June 2019. Six managers at the Ministry of Health (MOH), nine managers at DHMTs, 16 managers at OPDs, and 86 managers at healthcare centres participated in the study. Because of the low overall response rate (28.9%) and variance in the number of responses to questions, data were analysed descriptively. The results of this study portray the perception of the managers on the management of NCDs. Assessment of the public health system in Lesotho in terms of health service delivery showed that some health facilities in Lesotho’s public health system had pharmacists, pharmacy technicians, nurses, medical doctors, nursing assistants, public health nurses and community health workers (CHWs). Some of these health workers performed health promotion activities within their community. Some public health facilities collaborated with private health facilities on NCD management; however, some public health facilities did not collaborate with traditional healers. Public health facilities mainly had medicines and equipment used in the management xii of NCDs and some health workers were trained on how to use this equipment. However, some of the pharmaceutical and non-pharmaceutical staff at health facilities were not trained in drug and medical supply management, indicating a need for NCDs’ health service delivery strengthening. Assessment of the role of the pharmacist in the different PHC levels showed that pharmacists at the national, district and the PHC levels (except in healthcare centres) had roles to perform in the prevention and management of NCDs; thus, they work as part of a healthcare team at different levels of Lesotho’s health system. Finally, to develop the proposed NCD management structure for Lesotho's public health system, the results on perceptions of respondents on the management of NCDs in the public health system of Lesotho and literature review about chronic disease management models and the health system of Lesotho were integrated. In conclusion, the different elements of the health system of Lesotho need strengthening. Also, the proposed structure could be used to improve the already existing structure and also serve as baseline for further research on certain aspects of the public health system of Lesotho.