10 April 2024 by Limpho Sello

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Villagers in Maloraneng, Mokhotlong, urge Lesotho authorities to open a health post constructed by Letšeng Diamonds Mine as part of its corporate social responsibility several years ago. Photo Credit: Fredrick Mugira.

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“It gives me joy and a sense of relief knowing that I am contributing towards the prevention of early and unintended pregnancies (EUPs) in my village,’ shared Mamapholo Ntsiki, a 64-year-old dedicated village health worker.

Residing in the remote Maloraneng village within the Mokhotlong district, Ntsiki is among the dedicated village health workers striving to close the gap of unmet family planning in the area.

The 2014 Lesotho Demographic Health Survey (LDHS) reported that Mokhotlong has a 25 percent rate of unmet family planning needs, making it the district with the highest rate. This figure surpasses the national average of 18 percent.

Additionally, Mokhotlong ranks as the second-highest district for teenage childbearing at 24 percent, following closely behind its neighbouring district of Botha-Bothe at 25 percent.

Ntsiki is committed to assisting the district in tackling high teenage pregnancy rates by distributing contraceptives to underage girls and women in her Maloraneng village.

Maloraneng is part of the Molikaliko Health Centre’s coverage area. Nurse in charge of Molikaliko Health Centre, Mabokang Damane-Ntsie, highlighted Maloraneng as one of the villages grappling with early and unintended pregnancies (EUPs) and child marriages. From April 2022 to March 2024, Maloraneng contributed to 31 cases of EUPs.

Despite these challenges, Ntsie noted a promising uptake of family planning services. In January and February 2024 alone, Ntsie reported serving 146 clients with family planning services. She emphasised that these numbers include clients reached through outreach programs, VHWs, and walk-ins at the centre.

Traversing long distances in support of women

Despite facing long distances and harsh weather conditions, Ntsiki and her colleagues in the Molikaliko Health Centre catchment area remain dedicated.

They regularly undertake journeys, sometimes walking and even sleeping halfway, to reach Molikaliko Health Centre.

Their purpose is to attend frequent refresher trainings, obtain drug refills, procure medication for bedridden patients, and acquire family planning commodities.

On April 8, 2024, Ntsiki told Uncensored News that village health work is not for the faint-hearted, emphasising that there is nothing that brings her more joy than having an equipped health kit in her house. This allows her to provide the people in her villages with the right aid they seek from her.

“To me, providing contraceptives such as Sayana Press and oral pill contraceptives, the only two methods we are eligible to provide, fulfills both me and the country’s mandate of preventing unwanted pregnancies and planning families,” explained Ntsiki.

She added, “It gives me joy and a sense of relief knowing that I am contributing towards the prevention of early and unintended pregnancies (EUPs) in our village.”

Ntsiki explained that after assisting girls with contraceptives, she ensures they do not leave without engaging them in a discussion to gauge their understanding of the teachings provided by their peer educators. She said this ensures that both Ntsiki and the girls are on the same page regarding contraception knowledge and usage.

In Ha-Moeketsane, another remote mountainous area in Mokhotlong, ‘Malehlohonolo Lekhahlela, aged 31, is a Village Health Worker (VHW) that resides in Tsekong village, which is a two-hour walk from Moeketsane Health Centre.

Village Health Worker, ‘Malehlonoholo Lekhahlela.

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For Lekhahlela, walking is her only option because her village is inaccessible by vehicle. Despite extremely cold weather conditions, she often walks to the clinic to collect her health kit, which is beneficial to the community she serves.

During an interview with Uncensored News, Lekhahlela recounted a recent incident from April 5, 2024, when she had to collect a health kit and walk through the rain.

Lekhahlela, also a mother of three, said that she herself is a recipient of family planning commodities. She disclosed that she gave birth to her first child at the age of 16.

With the help of contraceptives, she was able to plan and have her second child at the age of 23. She explained that this gap allowed her to properly care for her first child and enabled her body to fully develop before having her second and third children.

“So, I advocate for what I have firsthand experience with, and I can confidently say that I am an example that contraceptives do work effectively when used correctly,” she explained.

Lekhahlela observed that many women in her village, especially young people, actively use contraceptives. She expressed satisfaction in supporting them with this critical aspect of family planning.

“Despite the interest of many, we face challenges with a few who opt not to utilise these services. Some individuals allege that we use them solely to bolster our statistics and receive incentives. Others express concerns about potential side effects,” she explained.

 UNFPA assistance in struggling districts

Violet Maraisane, the Communications Officer for the United Nations Population Fund (UNFPA) in Lesotho, highlights the persistent challenge of teenage pregnancy in the country, with an adolescent birth rate as high as 91 per 100,000 girls aged 15 to 19 years.

In response to such challenges, UNFPA, with the support of the Chinese government through the China International Development Cooperation Agency (CIDCA), allocated US$500,000 to procuring essential medical supplies.

These included oxygen concentrators, personal protective equipment for healthcare workers, family planning commodities, and other sexual reproductive health supplies. These resources were distributed to support the Ministry of Health at health facilities across the country.

Maraisane explained that the distribution happened in 2021 to ensure enough supply of commodities and safety of health workers during Covid-19.

Meanwhile, Mamapholo Ntsiki, a village health worker in Maloraneng, highlights the challenges she faces in collecting supplies. She said she often embarks on a nine-hour journey, braving the rain, to collect supplies from Molikaliko Health Centre.

Additionally, Ntsiki said she encounters obstacles such as the overflowing Khubelu river, which at times forces her to temporarily suspend her trips to the health facility to procure supplies for her community.

Khubelu River. Photo Credit: Fredrick Mugira.

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“Our greatest challenge here is the long distance to and from the clinic. This distance poses a challenge not only to us as health workers but also to our clients. Sometimes, women simply can’t undertake the journey to obtain contraceptives unless they have another pressing issue that necessitates a visit to the clinic,” she explained.

She added, “So, when we run out of supplies, the fear is always the possibility of unintended pregnancies. It is therefore crucial to ensure we always have an adequate stock with us.”

Ntsiki noted that monthly outreach programs by nurses at Molikaliko Health Centre play a critical role by helping bridge the gap, ensuring that even in situations where VHM may have to wait for supplies, the wait is not excessively long.

She explained that for women needing their dose of pills or Sayana, they are referred to nurses at the clinic. The nurses conduct a pregnancy test, and if the result is negative, they provide the contraceptives. Afterward, we continue our regular follow-up and supply at the community level.

‘We need operational clinic at Maloraneng’

A few years ago, Letšeng Diamonds Mine constructed a health post for Maloraneng villagers under its social corporate responsibility, aiming to facilitate easier access to health services.

However, Maloraneng villagers argue that logistical issues, particularly regarding nurses’ accommodation—a responsibility of the Ministry of Health—have rendered the clinic non-operational.

Ntsiki, representing the Maloraneng villagers, urged the authorities to ensure the full functionality of the Maloraneng Health Post. She said this entails having at least two nurses stationed in the area full-time, rather than solely during outreach programs.

“We face significant challenges when dealing with very sick patients, pregnant women who are due, or those presenting with complications while they are at home,” Ntsiki expressed.

Meanwhile, Family Planning High Impact Practices highlights that when appropriately designed and implemented, village or community health worker (CHW) programs can significantly increase the utilisation of contraceptives, especially in areas where there is a high unmet need, low access to services, and existing geographic or social barriers.

The publication noted that VHWs play a crucial role in reducing inequities in access to services by delivering information, services, and supplies directly to women and men in their communities. This approach eliminates the need for individuals to travel to health facilities, which may be distant or inaccessible.

The World Health Organization (WHO said village health workers represent a human resource group with immense potential. It noted that they can extend healthcare services to vulnerable populations, including communities in remote areas and historically marginalized groups.

By delivering culturally appropriate care, WHO said village health workers can address unmet health needs, improve access to services, tackle health disparities, and enhance health system performance and efficiency.