Lesotho

Lesotho is a country with a very high prevalence for both tuberculosis and HIV/AIDS, and the life expectancy at birth is 37 years. Under the health reforms include 10 Districts have been formed out of 23 Health Service Areas with new District NTP Coordinators and Basic TB Management Units.

In 2007, 4,280 new smear positive cases were diagnosed, 79% of the expected, well above the WHO target of 70%. Treatment success rate of smear positive cases improved to 73%, still below the WHO target of 85%. The general performance of the NTP of Lesotho has improved. Main issues are the extremely high HIV prevalence among TB patients (89%), the emerging MDR-TB problem, which is now addressed by upgrading the reference laboratory by Partners in Health, adapting Botsabelo Hospital with an isolation ward and treating MDR-TB cases with GLC approved second line drugs. Other priorities are basic quality DOTS expansion, with focus on the shortage of health staff, training of doctors and establishing a good and electronic recording and reporting system.

Role of KNCV Tuberculosis Foundation

In 2009, KNCV continued with Technical Assistance, training and financial support to the NTP. The focus of TA was on training of specialists and medical doctors, on capacity building of central unit staff of supervision, on Practical Approach to Lung Health (PAL) and ACSM.

Achievements

KNCV facilitated and participated in the two one day workshops for medical doctors (specialists form Queen II hospital, District medical doctors and private practitioners). These workshops were co-facilitated by NTP and partners: WHO and University Research College (URC). The main topics were Stop TB Strategy in general, ISTC, PAL, MDR-TB, TB/HIV and Infection Control.

Supervision was done using standardized checklists by NTP deputy manager, M&E specialist, KNCV general consultant and KNCV HR consultant. HRD issues were discussed and a draft HRD plan for strengthening Tuberculosis Control in Lesotho with priority strategies and actions to be taken was developed and discussed. Follow up of ACSM activities in the districts was done. A budgeted plans was made.

Next steps

KNCV will continue to support the Stop TB Strategy in Lesotho, with Technical Assistance and support to Human Resource Development.  Focus will be on:

Training

• ISTC curricula adaptation for the country needs for doctors (NTP, KNCV)
• Make training courses schedule on ISTC for 2010 to cover all doctors (NTP), with goal to reduce the percentage of TB diagnosis and TB treatment follow up without sputum smear examination.

Supervision

• Update, standardized checklist for (all) levels and pilot during the next supervision visit (NTP, WHO and KNCV)
• Follow up developed action plans for supervision, training and ACSM activities (NTP)
• Provide staff with updated job descriptions (NTP)
• Provide staff with necessary documents (e.g. TB manual, checklists, frames, SOPs, Posters) (NTP)
• Continue on-job training for Central Unit during joint supervision visit: one supervision visit per day to be able to account time for on-job training (KNCV).

Health Systems Strengthening with PAL

• Create National Working Group for PAL
• Workshop on PAL for consultants and medical doctors to work on draft guidelines (NTP).

ACSM

• Develop the plan at central level and cascade it dawn to districts
• Develop materials on IC for patients: cough etiquette; ventilation, and Patients Rights’ and care. (NTP)
• Develop and record on DVD a drama performance on TB.