Journal article
Healthcare workers' views on decentralized primary health care management in Lesotho: a qualitative study
BMC health services research, v 24(1), 801
11 Jul 2024
PMID: 38992665
Abstract
Lesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho's Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers' perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system.
We conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho's health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization's health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers' perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis.
Participants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds.
Our study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.
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Details
- Title
- Healthcare workers' views on decentralized primary health care management in Lesotho: a qualitative study
- Creators
- Ermyas Birru - Partners In HealthMelino Ndayizigiye - Partners In HealthGeorge Wanje - University of WashingtonTholoana Marole - Partners In HealthPatrick D Smith - Drexel UniversityMasebeo Koto - Ministry of HealthRyan McBain - Brigham and Women's HospitalLisa R Hirschhorn - Northwestern UniversityMathabang Mokoena - Partners In HealthAnnie Michaelis - Partners In HealthJoel Curtain - Partners In HealthEmily Dally - Partners In HealthAfom T Andom - Partners In HealthJoia Mukherjee - Brigham and Women's Hospital
- Publication Details
- BMC health services research, v 24(1), 801
- Publisher
- Springer Nature
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Community Health and Prevention
- Web of Science ID
- WOS:001266329100006
- Scopus ID
- 2-s2.0-85198404127
- Other Identifier
- 991022202110104721