LESOTHO: WORSENING PERFORMANCE IN HEALTH SECTOR

UNCLAS SECTION 01 OF 02 MASERU 000012

SIPDIS

SIPDIS

DEPT FOR AF/S, AF/EPS,S/GAC

E.O. 12958: N/A
TAGS: ECON KWMN TBIO LT
SUBJECT: LESOTHO: WORSENING PERFORMANCE IN HEALTH SECTOR

MASERU 00000012 001.2 OF 002



1. SUMMARY: In an effort to coordinate its response to
widespread poverty, the Government of Lesotho launched its
Poverty Reduction Strategy (PRS) in 2004. The recently released
review of progress under the PRS between 2004 and 2007 revealed
troubling data indicating declining health sector performance.
Deteriorating healthcare outcomes in Lesotho since 2000
demonstrate the tough road ahead for the nation's efforts to
improve public health. We are optimistic that U.S. involvement,
including the large forthcoming Millennium Challenge Corporation
investment in health infrastructure, as well as ongoing PEPFAR
programs, will prove critically important in reversing this
disturbing trend. END SUMMARY.

--------------
What is the PRS?
--------------


2. The Lesotho Poverty Reduction Strategy was a three-year
development framework formulated by government, development
partners, the private sector, and civil society organizations in
2004 aimed at ameliorating widespread poverty. The PRS is
merely a strategy document - not a funded program or
bureaucratic organization. The PRS was created through a
consultative process in which Basotho were interviewed on
poverty in the Lesotho context, how it affected them, and what
could be done to reverse the situation. The process designated
nine priority areas for poverty reduction, of which one is
healthcare. A review of the progress towards the targets set in
the PRS was publicly released in late 2007.

--------------
The Numbers, the Decline
--------------


3. In this PRS review, the indicators selected to monitor
progress in the health sector were evaluated as follows:

-- The maternal mortality rate is now at 762/100,000 live
births, an increase of 81% from 2001 to 2006. The main
contributing factors to the startling high maternal mortality
rate are the low level of Basic Emergency Obstetric Care (BEmOC)
and the impact of HIV/AIDS.
-- The number of births attended by skilled professionals
decreased from 60% to 55% between 2002 and 2006 due to human
resource shortfalls in the health sector -- one of its most
critical challenges. The review paints a similarly bleak
picture of the immediate future. However, tentative hopes for
improvement in the healthcare situation are pinned on the World
Bank's 20-year "Human Resource Development Strategy," which aims
to provide Lesotho with of a minimum level of trained healthcare
professionals.
-- The infant mortality rate rose by 10% between 2001 and 2006.
This is also largely attributable to the impact of HIV/AIDS and
the lack of BEmOC.
-- The mortality rate of children under five remained constant
at 113/1000 live births.
-- The proportion of children immunized against measles improved
marginally from 77% to 78% from 2000-2006. In November 2007,
Lesotho completed a nationwide measles immunization campaign
which likely brought the nation's children closer to full
vaccination.
-- The percentage of children receiving full immunization
against all major childhood diseases prior to age one decreased
from 77% to 68%. This has contributed to infant and under five
mortality rates remaining high at 91 and 113 deaths per 1000
live births, respectively. A recent survey indicated that most
of the nation's hospitals had exhausted their vaccine supplies
for one month or more during the past year. However the most
frequent single cause of institutional deaths in children are
diarrhea (22%),pneumonia (21%),malnutrition (13%),and
HIV/AIDS (11%).

--------------
Progress in HIV/AIDS Treatment,
But Not in Infection Rate
--------------


4. The review indicated significant progress regarding the
treatment of HIV/AIDS and TB. The number of people enrolled in
antiretroviral treatment doubled between 2005 and 2007. The PRS
Review specifically cited the infrastructure support of Baylor
University in this success. Despite improvements in HIV/AIDS
treatment, however, the prevalence of HIV/AIDS (the world's
third highest at 24%) and the new infection rate remains high,
indicating a lack of behavioral change.

--------------
Discouraging, But Help Is On the Way
--------------


5. COMMENT: The PRS Review statistics on health are

MASERU 00000012 002.2 OF 002


discouraging. Deteriorating healthcare outcomes in Lesotho
since 2000 demonstrate the tough road ahead for the nation's
efforts to improve public health. We are highly optimistic,
however, that the substantial U.S. involvement in the healthcare
sector, including the large forthcoming Millennium Challenge
Corporation investment in health infrastructure, as well as
ongoing PEPFAR programs, will reverse this disturbing trend.
END COMMENT.
NOLAN