Health Sector 2018, Independent Performance Evaluation
Lesotho, 2018
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LSO_2018_MCC-HS_v01_M
Health Sector 2018
Independent Performance Evaluation
| Name | Country code |
|---|---|
| Lesotho | LSO |
This performance evaluation is designed to address a range of evaluation questions and sub-questions about the program logic and current status of the health system, including:
1 Was the program evaluable?
2 Was the program implemented according to plan?
3 What was achieved with respect to patient outcomes?
4 What proportion of community members use the HCs and OPDs? Why do those who choose not to seek treatment, not seek care?
5 What was achieved with respect to health professional outcomes?
6 Did the NHTC investment contribute to increased enrollment and graduation from NHTC?
7 What was achieved with respect to system outcomes?
8 What lessons can MCC or the Government of Lesotho apply in future programs related to program design, implementation, and sustaining results? What could have been done better? How so?
The evaluation provides descriptive analysis of trends, pre-post comparisons, and statistics from a single time period, complemented by qualitative analysis. The exposure period is a minimum of four years.
Key findings include:
Improved Service Delivery Platform
Crucial health infrastructure was built or rehabilitated and equipped for use, including 138 health centers (HCs) and 14 outpatient departments (OPDs), though with significant delays and required substantial complementary investment from the Government of Lesotho.
Consensus suggests that the Project provided a necessary platform for health service delivery throughout the country. However, many new HCs lack sufficient space to meet increasing demand, and concerns about the quality of construction and equipment persist.
*National Reference Lab and Blood Transfusion Services have increased their operations, though budgetary factors constrain their full service expansion.
Patient and Staff Perceptions
Patient satisfaction with and use of the facilities has increased, though barriers still exist for pregnant women and people in peripheral communities.
Staff levels and satisfaction with their living and working conditions have improved. Yet budget constraints keep more than a quarter of sampled health facilities staffed below the current five-nurse staffing complement, especially in hard-to-reach areas.
Progress toward Health Outcomes
Findings indicate that most population-level health outcomes will require more time to materialize, contrary to MCC's expectations at the outset, though trends in health care use and improvements in some health-related indicators are encouraging.
Sample survey data [ssd]
Patients, health professionals, health care system, districts, OPDs, HCs
Scope
| Topic | Vocabulary |
|---|---|
| Health | MCC Sector |
| Hospitals |
Coverage
The Health Project had national coverage in terms of the health care facilities improved and communities benefiting
Producers and sponsors
| Name |
|---|
| Pim de Graaf |
| Name |
|---|
| Millennium Challenge Corporation |
Sampling
Central level
No sampling was carried out for data collection at central level, because all relevant partner-organizations were included in the data collection.
Local level
At the local level, in order to limit the amount of data and effort while preserving sufficient numbers to allow for observation of trends and variations, the following sampling steps were taken to achieve a broad representation of perspectives on the basis of population numbers, variations in geographical conditions and available resources for this evaluation.
Districts
Six out of the 10 districts in Lesotho were selected for data collection. This number was presumed to cover sufficient population and health facilities to be representative. The sampling was stratified: first, in view of its population size, Maseru district in the lowlands was included. Then, the other five districts were randomly selected from the remaining nine. In order to cover sufficient geographic diversity, at least one of the mountain districts needed to be included. This was motivated by the known climate, access and isolation issues in those districts. If this did not happen through random sampling, one of the lowlands/foothills districts would have been dropped (randomly selected) and replaced by one of the four mountain districts, again randomly selected.
All OPDs reconstructed in the six districts were included. In each OPD, there were two target groups of professionals: The manager and two doctors. Prior to and during the visits of the evaluation team, in agreement with the manager of the OPD/hospital, the survey-respondents were selected on the basis of availability and convenience. Length of tenure was an additional selection criterion, if choice existed.
In order to limit the number of Health Centers to visit while also ensuring sufficient representation, a sample of three Health Centers were randomly selected in each district. In Maseru district an additional two Health Centers were randomly selected because of the population size, which accommodates around 25% of the total population of the country. Further, a minimum of six isolated Health Centers spread over the five districts were to be included, in order to ensure their sufficient representation in the study. If the above random sampling resulted in less than six, additional isolated Health Centers would have been selected randomly, with a maximum of one per district. If the two Health Centers supported by the Red Cross were not included in the above sampling, they would have been added. In term of health care staff, two nurses were to be invited to participate in the survey: the head nurse and the newest nurse. When the head nurse was not available, another nurse was selected on the basis of availability and longest serving years.
Six patients were also targeted at each OPD and HC (two adult women, two adult men, two care givers). Consecutive patients exiting the health facility were asked to participate, which continued until the sample size had been reached for each of the 3 categories to be sampled. If there were insufficient patients from one or more of the 3 categories, no substitution occurred. However, the timing of the survey was determined to ensure sufficient availability of patients. Concretely this meant that the survey was carried out between mid-morning and the end of the morning, when consultations are typically ongoing.
Quantitative
The above-mentioned sampling and selection procedure resulted in 26 health centers and 10 OPDs in six districts (of 10 total districts in Lesotho) for the HFS sample. The HFS was implemented in all these facilities.
With the exception of male patients, the response rates for the sub-groups targeted are at or above 100%. In some health facilities, there were simply no (or insufficient numbers of) male patients, which was compensated by including more female patients or care takers.
Observation modules of HFS were also completed in all 36 facilities.
Qualitative
In all 26 selected health centers, the planned FGD VHWs took place. The discussion was conducted in Sesotho and later transcribed and translated in English.
The planned semi-structured interviews with members of the District Health Management Team (DHMT) took place in the targeted six districts. However, in practice became FGDs with a varying number of DHMT members (mostly 4-6 members). Also, the interviews with doctors in each of the 10 OPDs were conducted.
At central and national level, most of the planned key informant interviews were carried out. Where respondents were unavailable, the evaluator attempted to collect information by email.
Survey instrument
A Health Facility Survey (HFS) conducted in 2018 built on an earlier HFS conducted in 2011. HFS 2018 covered 26 HCs and 10 OPDs and was conducted from February-April 2018. This survey collected data from health care workers (managers and health professionals) about the physical and psychological working environment and tools, career issues, how they perceive the patient experience, the use of the EMRS and HCWM, and views of characteristics and quality of the services delivered in their current health service. HFS also interviewed patients/users of OPDs and Health Centers to collect data on their perception of the health services and the care provided, obstacles to care, physical environment, staff attitude, quality of care and general atmosphere in the country with regards to stigmatization of certain population characteristics like HIV. Finally, the survey included a module that collected observation data. HFS was conducted in Sesotho. All surveyors were proficient in Sesotho and English and had relevant professional qualifications.
Qualitative data collection included observations, key informant interviews with stakeholders at the Ministry of Health, the Lesotho Millennium Development Agency (which is the follow-on entity to the Millennium Challenge Account Lesotho), OPDs, and members of District Health Management Teams, and 26 focus groups with 181 village health workers. The team also used extensive quantitative secondary data from Demographic Health Surveys, Annual Joint Reviews by the Government of Lesotho, and other health statistics.
Data collection
| Start | End |
|---|---|
| 2018-02-01 | 2018-04-30 |
| Name |
|---|
| Pim de Graaf |
| Basotho Staff |
Access policy
Millennium Challenge Corporation
Millennium Challenge Corporation
https://data.mcc.gov/evaluations/index.php/catalog/217
Cost: None
Data Access
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Contacts
| Name | Affiliation | |
|---|---|---|
| Millennium Challenge Corporation | US Government | opendata@mcc.gov |
Metadata production
DDI_LSO_2018_MCC-HS_v01_M
| Name | Role |
|---|---|
| Millennium Challenge Corporation | Review of Metadata |
2019-08-28
Metadata version
Version 2 (June 2020). Edited version based on version 2 (DDI_LSO-HEALTH-PDG-2018-v2) that was produced by the Millennium Challenge Corporation.
The Health Project was designed to improve health outcomes for people using the HCs and OPDs renovated under the Lesotho Compact. In addition, patients in all hospitals in the country are potential “participants” since blood transfusions are given in all of the hospitals, with more frequent use in Maseru hospitals. The Project also provided a considerable amount of training and was intended to support increased enrollment at NHTC, so health professionals and students can also be considered “participants.”