This first installment of our two-part series examines the layers of Lesotho’s healthcare crisis, from chronic staff shortages to inadequate medical supplies that send patients on a desperate search for basic medication like Panadol.

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8 January 2024 by Pascalinah Kabi

Est Read Time: 4 min(s) 13 sec(s)

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Mphonyane Thetso works at Nazareth Health Centre as midwife and assistant to the nurse in charge. Credit: Pascalinah Kabi.

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At 4 a.m., Mphonyane Thetso is in the fragile grasp of sleep, having just completed a gruelling 24-hour shift.

The shrill ring of her phone shatters the night’s tranquillity, abruptly summoning her back to duty. Another colleague at Nazareth Health Centre is indisposed. This creates a gaping void in the centre’s already overstretched team.

Despite the deep-seated exhaustion that envelops Thetso, she is compelled to rise once more. In her reality, refusal is not a consideration.

As a midwife and the assistant to the nurse in charge, Thetso’s life revolves around an unending cycle of births, emergencies, and relentless care for those in need.

The Nazareth Health Centre serves as a vital lifeline to 69 villages, offering hope to nearly 30,000 individuals. Within its walls, the team, though modest in size, remains steadfast.

Led by the advanced midwife and nurse in charge, ‘Mantuta Thelingoane, the group includes four midwives and two interns.

In this tightly-knit ensemble at Nazareth Health Centre, each member plays a vital, indispensable role. Their united efforts are the foundation of the community’s health and well-being.

“It’s very hectic. We have a burn-out,” Thetso openly shared with Uncensored News on October 30, 2023, highlighting the intense pressure they face daily.

Thelingoane, understanding the centre’s significance, suggests an elevation in its status. She proposes that Nazareth Health Centre be recognised as a filter clinic, considering the substantial population of 29,882 it serves.

However, the challenges confronting Thetso and her team, primarily due to chronic staff shortages, are not unique to their facility. This issue is a common thread running through numerous health facilities across Lesotho.

Dr. Lucy Mapota, the Ministry of Health’s Director of Clinical Services, affirms this, stating, “Staff shortage is a reality on the ground.”

Addressing specialised care shortages.

The evolving landscape of healthcare and the mounting challenges of specialised skill shortages are acutely felt in Lesotho, as Dr. Mapota, an authority in the field, points out.

She argues that the changing nature of diseases demands a more robust and diverse staff complement in healthcare facilities.

“Previously, a typical staff lineup in a health facility included a doctor, a nurse, a pharmacist, a radiologist, and a laboratory technician. However, the medical field is rapidly evolving,” Dr. Mapota explains.

She emphasises the emergence of new specialised roles, “There are many other cadres now, which should be integral parts of the health system. They ensure complete healthcare for our patients at any point in time, tailored to their individual needs.”

In Lesotho, according to Dr. Mapota, there is a glaring gap in the skilled personnel required to meet these evolving healthcare demands.

“Our ability to expand our services is limited, even as the disease burden grows. The need for specialised skills is increasing, but we face significant challenges in providing specialised care. For example, while we have many nurses, we lack professionals in critical specialised areas.”

At Nazareth Health Centre, midwife Mphonyane Thetso and her colleagues grapple daily with these chronic staff shortages, pushing themselves beyond limits to provide the best possible care.

“I know change isn’t imminent, so we must keep pushing. We view our work as a divine mission. Like students aiming to pass an exam, we strive to excel in our roles, driven by our passion for nursing rather than monetary rewards,” Thetso shares passionately.

She finds strength in the camaraderie and support of her colleagues, who share a collective spirit of resilience and teamwork.

“We don’t keep score of who’s done what. It’s about stepping in when needed. There’s a real sense of teamwork at Nazareth.

“If one of us is on the brink of collapse from exhaustion, someone else will step up, saying, ‘I have finished my tasks, go rest, I’ve got this.’ It is this unity that keeps us going; otherwise, we’d have collapsed under the strain,” Thetso explains, highlighting the crucial role of teamwork in navigating these challenging times.

She is also lucky to have supportive colleagues who do not keep record of who has done what before they can step in to help.

“We are working as a team to make Nazareth what it is today. If I feel like I am going to collapse from exhaustion, the next colleague will say, “I think I have covered my work this side, go and sleep. I will take it over from her.” Working as a team is the only thing that keeps us going, otherwise we would have collapsed,” Thetso said.

The road to solutions: A proposed recruitment commission

As Thetso and her team contend with the pressing issue of staff shortages, Dr. Mapota acknowledges that these challenges extend beyond the scope of the Ministry of Health, which governs Lesotho’s health sector.

A significant concern overshadowing these issues is the nation’s substantial wage bill, long lamented by the International Monetary Fund.

Dr. Mapota points out the direct impact of this financial strain on the health sector’s staffing capabilities.

“Our challenge is compounded when the Minister of Finance indicates that the wage bill is high, especially when we seek to recruit additional staff for the Ministry of Health,” she explains.

Another hurdle in augmenting the workforce is the lengthy recruitment process managed by the Public Service Commission, the body responsible for hiring public service employees in Lesotho.

To streamline and expedite this process, the Ministry of Health proposes a significant change.

“We want to establish our own recruitment commission, similar to the models followed by the Lesotho Defence Force and the Lesotho Mounted Police Service.

“This would allow us to directly address our specific staffing needs and significantly reduce delays in recruitment. Sometimes, we have vacant positions, but the protracted recruitment process hinders our ability to fill them promptly,” Dr. Mapota elaborates on the proposed solution.