Health Sector Capacity

Sechaba’s experience in the health sector goes back to 1988 when the founding members undertook work for the Ministry of Health and the World Bank.  Since then a variety of studies have been conducted for Government and the Christian Health Association of Lesotho (CHAL), as well as for various programmes and projects supported by donor agencies.  Below a brief description of these research projects is given to illustrate the scope and depth of Sechaba’s experience


Health & Family Planning Services In Lesotho: The People’s Perspective (1988). Prepared by David Hall and Gwen Malahleha for the Ministry of Health and the World Bank.  This was one of the first “beneficiary assessments” sponsored by the World Bank in the late 1980s.  The objective was to obtain qualitative information about the “knowledge, values and behaviour of the target population in the areas of health, family planning and nutrition”. Using participant-observation and conversational interviews over a period of nine weeks information was gathered from one urban and two rural sites.  In addition to revealing in-depth information about sensitive topics – such as views and use of family planning methods – the study came up with practical recommendations, based on interviewee suggestions, for improving modern health facilities and services.   The results of the study were used by the client in preparing World Bank-funded Health and Population Project as well as by private health organisation (see below).


An Evaluation Of The Scott Hospital Community Based Distribution (CBD) Family Planning Programme (1992). Prepared by David Hall and Tony Daly for Scott Hospital, Morija and Marie Stoppes International. This programme was started by Scott Hospital following recommendations made in the 1988 that noted the need for villagers to have easy access to family planning devices.   Over a three year period Village Health Workers were trained and supplied with different contraceptives to make available to women in their communities. Sechaba’s evaluation showed that the project had a significant impact in its areas of operation.


An Evaluation Of Christian Council Of Lesotho’s Aids Education Unit 1989-1992.  Prepared by Brigit Westphal Victor and Jeannette Bloem. Sechaba assisted in this evaluation of the Lesotho’s first non-government AIDS awareness programme.   Results showed that significant progress had been made towards the objective of raising awareness and of supporting individuals and families afflicted by AIDS.   However, in view of the spread of the disease and the worsening socio-economic situation, calls were made for intensified efforts.


An Evaluation of the Community Alcohol Rehabilitation Programme of Scott Hospital (1993). Prepared by Debby Gill and David Hall for Scott Hospital, Morija.  At the time of the evaluation Scott Hospital in Morija was the only institution in the country with an established alcohol rehabilitation programme.  The evaluation looked at all aspects of the programme and included a community survey, an ex-client survey and an assessment of CARP’s approach to treatment and prevention.


A Beneficiary Assessment Of The Second Population, Health And Nutrition Project
Prepared by Debby Gill and David Hall for the Ministry of Health and Social Welfare and the World Bank.  With the second Population Health and Nutrition Project due to end in 1994, Sechaba Consultants were commissioned to assess the views of those people who had benefited from the Project, including users of health services, staff of improved facilities and Ministry personnel.  It included an assessment of trends in Health Centre use, reporting and morbidity data. The report also compared changes over the five year period since the first beneficiary assessment was conducted, with particular attention being paid to people’s views of the up-graded facilities, including Leribe, Butha-Buthe and QEII hospitals.


Health in Lesotho - 1993 Profile. Prepared by John Gay and Debby Gill for the Ministry of Health and Social Welfare, Government of Lesotho in collaboration with EC, World Bank and W.H.O., 1993.  Over a period of one year Sechaba Consultants, with funding from WHO, the World Bank and European Community, assisted the Ministry of Health prepare the first comprehensive health profile of the country.  This entailed an extensive review of available literature, collection, compilation and analysis of health data and interviews with health professionals, donors and ordinary people.  The report provided details on disease prevalence, health systems (including government policies, organisational structures and financing) as well as an assessment of the effectiveness of the health system.   Annexes include morbidity data for both in-patients and out-patients as well as an analysis of Mother and Child Health Clinic data.  The Minister of Health and Social Welfare described the report as “a Bible” for all health workers, and encouraged the Governments partners in health to use it to identify areas of common interest for future joint ventures.


An Evaluation Of The Lesotho Red Cross Society, 1993. Prepared by Jeanette Bloem and Sesomo Phalatsi.  The LRCS runs a health programme that includes clinics, AIDS education, rural sanitation and blood donor recruitment.  As part of an overall evaluation of the LRCS, Sechaba Consultants reviewed the extent to which the objectives of the health programme had been achieved and made recommendations for the next stage of the programme.


A Baseline Survey Of 42 A-Team Soccer Player In Lesotho With Regard To Their Sexual Behaviour And Attitudes To Aids (1994). Prepared by Debby Gill for AIDSCAP and CARE.  This survey was carried out in preparation for a project targeting football players as role models.  The baseline was necessary to establish current sexual behaviour patterns and awareness of AIDS at the start of the project.


A Needs Assessment Baseline Survey of the Matebeng Area (1995).  Prepared By Jeanette Bloem for LPPA. This study was commissioned by LPPA with the aim of developing a project designed to promote reproductive health as an integral part of family planning among young women in a very remote part of the country.  The survey used a mixture of quantitative and qualitative methods and included the checking of clinic records.


Baseline Epidemiology and Medical Services Survey, Phase 1B (1996).  For The Lesotho Highlands Development Authority, Contract 1010.  Working together with the Medical Research Council of South Africa, Sechaba Consultants played a key role in the Baseline Epidemiology and Medical Services Survey for Phase 1B of the Lesotho Highlands Water Project.  The study covered 83 villages in 400 sq km of remote, mountainous territory.  The majority of the villages were not accessible by road and could only be reached via mountain paths on foot or horseback.   As the study involved the collection of blood and urine samples this required the management of a field station which consisted of centrifuge, deep freeze, fridge and generator which was staffed by qualified technicians.  Over 2,000 people were included in the sampling.  The study included a KAP survey, a nutrition survey, analysis of the prevalence and intensity of vectors of human disease, communicable diseases, occupational health and industrial hygiene and a medical services survey.  Recommendations were made for a future monitoring and audit programme.  Sechaba Consultants provided field staff, data analysts and the deputy project manager.


National Poverty and Sustainable Livelihoods Study (1999).  For The Ministry Of Education, Irish Aid, Unicef, The World Bank and WHO.  This is the third national study of poverty conducted by Sechaba Consultants, with previous studies being undertaken in 1991 and 1994.  This current study includes far more on health than any of the others.  It involves a nation-wide household survey (3,000 households) which covers morbidity (complaint, days lost, where treated, time to reach treatment, time waiting, charges and reasons for not seeking treatment); Under 5s, (including height and weight, vaccinations and breast feeding); pregnancies (including data on ANC, PNC attendance, outcomes, problems, where delivered, and birth registration) and mortality (sex, age, and reported reason for any deaths in last 5 years).  The focus group discussions were held with Village Health Workers, Traditional Birth Assistants, Nurse Clinicians, Nurse Assistants and Doctors, Pregnant Women, Mothers of Children Under 5 as well as men.  Topics include most frequent illnesses, reasons for being consulted, short-comings in care, specific reasons that influence people to seek a particular cadre or type of health worker and so on.


Review of Policies that have an Impact on HIV/AIDS/STD in SADC Member States, For The SADC Health Sector Co-Ordinating Unit, 2000. Sechaba Consultants was contracted by the SADC Health Sector coordinating unit to undertake this study together with Carewell SA. The aim of the study was to review policies that have an impact on HIV/AIDS/STD in SADC member states and the region, and to make suggestions on how states could harmonise policy development in the field of HIV/AIDS/STD. An intersectoral approach was essential.   The first phase of the study was completed in June 2000.


Condoms In Lesotho, Young People’s Perceptions of the Lovers Plus Campaign and of Barriers to Consistent Condom Use (2000). Prepared by David Hall and ‘Mamello Moleli.  The Society for Family Health (SFH) has been selling Lovers Plus condoms in Lesotho since 1995.  In 1998, SFH repositioned the brand to target black urban youth more aggressively and launched a campaign in keeping with this strategy.  This campaign is based on qualitative and quantitative research in urban areas of South Africa where it is hoped that Lovers Plus will become the “aspirational brand” for trend setting urban youth.


SFH’s current project in Lesotho, being implemented by CARE International, does not permit extensive formative research leading to the production of Lesotho-specific promotional materials.  In the interests of economy, SFH is using campaign material developed as part of its South African programme but needs to test the hypothesis that  “some significant portion of youth in Lesotho find the campaign appealing and most do not have any strong negative feelings towards the messages and images disseminated through the campaign”.


With this prime objective in mind SFH contracted Sechaba Consultants to undertake a study of campaign perception among young people (15-24 years) in two urban areas of Lesotho.  A secondary objective was “to identify barriers to consistent condom use among sexually active youth” as this has been shown to be a problem in South Africa where awareness of HIV/AIDS is high but a very low percentage of sexually active young people use condoms consistently.


Lesotho Health Sector Reform Baseline Assessment (2001). Prepared by Jeanette Bloem, Debby Gill, David Hall Henry Lucas, Rudolf Schumacher and Garth Singleton. In April 2001 the Ministry of Health and Social Welfare contracted Sechaba Consultants in a joint venture with Ziken to undertake a baseline assessment of the Health Reforms.  The baseline was developed following a series of meetings between the Ministry of Health and Social Welfare (MOHSW) and the Consultants when a list of indicators, sources of information, data collection methods and instruments was agreed upon.  The information was drawn from a household survey, a survey of all hospitals as well as a random sample of health centres.  At facility level interviews were conducted with both the health providers and the beneficiaries using the facilities. The basic objective of the consultancy was to provide a snap-shot in time rather than an analysis of causes and effects.  The report was designed to be a reference point for others who need to locate information in an accessible format in one place.  The format used enables the Ministry to update the report with relative ease when needed.  The study focused on six areas which were: burden of disease, utilization, coverage, quality of care and technical efficiency, equity of access and allocation of resources/subsidies, client and provider satisfaction.


HIV/AIDS Behavioural Surveillance Survey (2002). Conducted for Family Health International, Lesotho Ministry of Health, Lesotho AIDS Programme Coordinating Authority,  USAIDS. Sechaba Consultants was part of a team that undertook a Behavioral Surveillance Survey. The BSS methodology is a monitoring and evaluation tool designed to track trends in HIV/AIDS-related knowledge, attitudes and behaviors in subpopulations at particular risk of the infection, such as female sex workers, injection drug users, migrant men and youth.  The objectives of the BSS are to help provide information that will help develop a system to track behavioural trend data for the high risk and vulnerable target groups that influence the HIV/AIDS epidemic in Lesotho


Sexual Violence Against Women In Lesotho (2003). Prepared by Tulane University, Sechaba Consultants and Care Lesotho. This study was undertaken to explore the nature and magnitude of sexual violence in Lesotho. In addition, the study collected information on the effects of the Sexual Health and Rights Promotion (SHARP!) program.  The specific objectives of the study were to gather the magnitude of sexual violence among Basotho women and provide descriptive data on the most common types of sexual coercion and assault experienced.


How Can You Tell The Sun Not To Shine?  Behavioural Surveillance Survey Report (2004). Prepared by Thuso Green, Dr Kimane and Dr Moteetee.  Sechaba Consultants carried out a study of farm workers and mine workers in order to determine factors that influence sexual behaviour of mine and farm workers, the level of knowledge and practices on prevention and control of STI/HIV/AIDS and systems from which they access relevant services.  The study included interviews of 173 farm workers and 843 mine workers.


LAPCA/MOHSW, Government of Lesotho Health Sector Reform-HIV/AIDS Project, Phase 1- End-Of-Project Evaluation (Crown Agents) (2005).  Sechaba was contracted by Crown Agents of South Africa to evaluate work that undertaken with regard to their support to specific capacity building activities for the GOL as well as for non-governmental organisations relating to the National AIDS Strategic Plan of Lesotho.


Putting people first