Health Systems Policy & Management
The Lesotho Boston Health Alliance (LeBoHA) undertook an assessment to understand and evaluate the financial systems in our pilot districts and have started to address issues of bottleneck in procurement, budget monitoring, and spending processes, in addition to the MTEF (medium term expenditure framework) accounting formats. The LeBoHA team proposed standard outcomes and outputs for the health sector to streamline the MTEF process. These simplified outputs were implemented by the MOHSW when they combined the district 2009/10 budgets. LeBoHA continues to assist in simplifying the costing process as the MOHSW works to combine the district budgets and input the budgets into the IF-MIS software. LeBoHA is also working on many other financial management strengthening activities and capacity building projects that are specific to the challenges faced at each institution.
The Lesotho Boston Health Alliance (LeBoHA) is addressing management at the national, district, and provider level with an aim towards strengthening decentralization and improving the quality of the district systems of care. The LeBoHA team worked with Maluti Adventist Hospital, Motebang Hospital, and Berea Hospital to test systems for quality improvement and address priorities in management strengthening and quality assurance. Our Management Strengthening Program is fully operational and customized quality improvement plans for Motebang, Maluti and Berea Hospitals were developed in collaboration with hospital management. Accreditation standards and Annual Joint Review indicators form a critical component to these management improvement plans. We also worked with the District Health Management Teams (DHMT) to identify areas in their operational plans that require technical support. We would like to identify results from the beta testing of our management strengthening and quality improvement work in the Leribe and Berea districts to suggest tested and evidence-based interventions for expanding and disseminating relevant and effective approaches for all districts.
Within the last few years, the Ministry of Health and Social Welfare begun to focus on monitoring the quality of health care services through the development of accreditation standards for hospitals and health centers and the formation of a Quality Assurance (QA) department within the MOHSW. Subsequently, the districts turned their attention to improving the quality of their services and the process of service delivery. LeBoHA assisted in forming QA committees at Maluti and Motebang Hospital to provide overall leadership and management, trained over 50 staff on QA techniques, and initiated 3 QA projects at Maluti and 4 projects at Motebang Hospital. The QA teams appointed by the overseeing QA committee are trained to collect and analyze data to both identify the problems and monitor their changes. They also learn how to systematically identify and implement possible solutions. The results of LeBoHA’s mentoring and training have been tremendous. For example, the waiting time at the outpatient department has decreased by 45%, proper ARV administration to inpatients has increased by 40%, and proper disposal of sharps has increased by 40%.
In 2004, the Lesotho-Boston Health Alliance (LeBoHA) began to address critical service delivery issues by building capacity for individual problem solving through Problem Solving for Better Health® (PSBH) with support from the Dreyfus Health Foundation. PSBH® participants develop an individual action plan that addresses a problem they face in the workplace that they can solve using available resources. After eight workshops, we have trained over 500 front-line and mid-level caregivers and managers in this methodology. This has proven to be an extremely effective tool for health services improvement and is a core component of our work.