This second installment of our two-part series examines the layers of Lesotho’s healthcare crisis, from chronic staff shortages to inadequate medical supplies that send patients on a desperate search for basic medication like Panadol.

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10 January 2024 by Pascalinah Kabi

 Est Read Time: 5 min(s) 55 sec(s)

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Lesotho’s Minister of Health, Selibe Mochoboroane. Credit: Pascalinah Kabi

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As dawn breaks, Litaba Mosebi collapses into bed, utterly exhausted. Merely two hours later, he stirs, compelled by the need to urinate.

As he lifted his head, a wave of hot sweat sweeps over him. “A terrible hangover,” he thinks. It is 2 April 2023.

But three days later, his condition worsens. His throat, now a source of unbearable discomfort, rebels against every attempt to eat or drink.

By April 9, his body is in full revolt, each swallow an expedition through pain. In sheer desperation, Mosebi arrives at Paki Health Centre in Mazenod, well before dawn.

His anxious wait, amidst a swelling queue and ticking clock, culminates at 10 am. The diagnosis was a mix of relief and frustration: flu and tonsils, nothing deadly.

The prescription, however, is incomplete. The clinic has run out of two essential medications – paracetamol and another not clearly spelled in his booklet.

His pockets are as desolately empty as the clinic’s medication shelves.

“What benefit is there in diagnosing an illness,” Mosebi rhetorically questions during a December 15, 2023 interview with Uncensored News, “if you are then told it cannot be treated due to a lack of available medication?”

National Drug Service Organisation: Central medical stores for Ministry of Health

A van, distinct in its white and yellow livery, kicks up a cloud of red dust as it speeds along a gravel road in Mazenod.

Marked with the emblem of the National Drug Service Organisation (NDSO) on the driver’s door, it embarks on a crucial mission, akin to many other similar vans, to deliver essential medications to both urban and remote areas across the country.

Amidst swirling dust and rugged terrain, these vans symbolise a lifeline, bridging the gap between the nation’s health needs and its scattered communities.

However, the task of delivering life-saving medications to health facilities is not always a guaranteed success for these vehicles.

“Some of the reasons we run out of stock of certain medications is that there is only one company that procures medications on behalf of the country, and that is NDSO,” explains Dr. Lucy Mapota, a director of clinical services at the Ministry of Health, in an interview with Uncensored News on January 5, 2024.

Established by the government of Lesotho in 2007, as noted in Supplement No.4 to Gazette 19, the NDSO operates as the central medical store for the Ministry of Health.

It plays a vital role in procuring, storing, and distributing medications to health facilities nationwide, serving both public and private sectors.

“I drank hot water with chillies; I didn’t have money for drugs.”

In his modest two-room family home, Litaba Mosebi from Mazenod boils water, resorting to a home remedy of hot water and chillies in desperation.

This brought some relief, yet also a deep-seated frustration. The free services at Paki Health Centre, a haven for the poor, felt like a hollow promise with empty medical drug shelves.

“The services become practically inaccessible when the clinic can’t provide the medication needed for cure. It’s not just me experiencing this,” Mosebi explains.

This harsh reality hit home again months later when his underage niece fell ill. Back in the all-too-familiar bleak surroundings of the health centre, he faced the same predicament.

“On 19 July 2023, I took my niece to the same clinic due to lack of money,” he says. “Some of the prescribed medications were unavailable. We were told to buy them from a pharmacy, but as usual, we couldn’t afford them,” Mosebi adds.

Ministry of Health’s Director of Clinical Services, Dr. Lucy Mapota, emphasises the importance of health facilities providing services in line with international standards for universal health access.

“Managing the whole person means considering the journey from home to the facility. Is the care we provide accessible? Do patients have the means to travel? It’s not enough to diagnose a high blood pressure and then have no drugs to treat it. In that case, the patient hasn’t truly received the service.”

She highlights the impact of out-of-pocket expenses on patients’ socio-economic status. “It can lead to poverty,” she says.

Mosebi feels that the recurring drug supply problems at facilities like Paki Health Centre make healthcare inaccessible to the poor.

“I think healthcare is for the rich. The poor are left with clinics lacking necessary medications,” he laments.

Dr. Mapota notes that international standards for universal health coverage, which the Ministry of Health adheres to, dictate that health services should not financially ruin patients.

“Healthcare shouldn’t impoverish or cause financial catastrophe,” she explains. “While we anticipate challenges with medications, they shouldn’t compromise patient care.”

Pregnant women face challenges in accessing essential calcium gluconate and iron supplements

Nazareth Health Centre is renowned for its safe delivery environment. In September 2023 alone, the centre recorded 22 safe deliveries. Three additional high-risk pregnancies were transferred to St Joseph’s Hospital in Roma.

While specifics of these cases remain confidential, ‘Mantuta Thelingoane, a nurse in charge and advanced midwife at Nazareth Health Centre, notes that complications often arise from iron deficiency.

Clinicians typically administer ferrous medication to pregnant women with low iron levels. However, Thelingoane reveals a critical shortage: “We do not have medical drugs here,” she said in an October 30, 2023, interview with Uncensored News.

“For instance, it is dangerous for a pregnant woman to have high blood pressure, and we give them calcium gluconate to prevent this. But I don’t know when we last had this drug in our centre. There is no ferrous here either, a medication used to increase the unborn child’s iron intake.”

Thelingoane explains the vital need for iron during pregnancy for both mother and baby, yet most essential drugs are unavailable at the Centre.

This scarcity is particularly concerning given the majority of the Centre’s nearly 30,000 underprivileged population.

“They can’t afford these drugs, especially the many required types of calcium-related drugs,” she says, emphasizing how this hampers smooth service delivery. The Centre routinely tests pregnant women for iron levels, with results often indicating deficiencies.

“We have nothing to give them,” Thelingoane laments, highlighting the dilemma of treating versus preventing iron deficiency. Additionally, the lack of doctors at the Centre means high-risk pregnancies, such as those with iron deficiency, must be referred elsewhere, often incurring unaffordable transport fees for the patients.

“We tell our patients we don’t have drugs,” Thelingoane says. “Government funds for drugs are insufficient. We advise women to eat well, but it’s tough to convey this message to poor, pregnant women facing complications due to drug shortages.”

Dr. Lucy Mapota, Director of Clinical Services at the Ministry of Health, acknowledges the budgetary constraints impacting drug availability.

“Our ministry’s budget ceiling limits our drug procurement. We prioritise based on immediate life-saving needs, which means some patients may not receive necessary medication,” she explains, outlining the challenges in addressing these drug shortages.

Dr. Mapota advocates for local drug manufacturing in Lesotho

While Dr. Mapota acknowledges that drug shortages in Lesotho are more seasonal than persistent, she emphasises that a key solution lies in “having enough budget.”

Moreover, she advocates for the local production of drugs.

“Lesotho is not manufacturing drugs, which is an avenue we haven’t explored. The benefits of producing our own drugs are manifold: we’d be aware of the demand and supply within the country, it would foster skill development, and ultimately, we could produce high-quality drugs,” she explains.

Dr. Mapota points out that the challenge often isn’t the absence of drugs internationally, but the need to ensure manufacturers meet safety and quality standards.

“There are situations where a drug is available, but we cannot procure it due to the manufacturer’s substandard quality or safety concerns. We must ensure that the side effects of drugs don’t lead to new health issues instead of curing existing ones,” she states.

Inquiring about Lesotho’s hesitance to venture into drug production, Dr. Mapota references the recent Lesotho Medicines and Medical Devices Control Act of 2023.

“The absence of relevant policies often hinders progress. With the enactment of the Medicines Act, we’ve laid the foundation for drug manufacturing. What remains is for the Ministry of Health to establish the necessary structures and regulations.

“This Act paves the way for companies to manufacture drugs locally. Additionally, there’s a need to expand our pharmaceutical department within the Ministry, which is currently quite limited,” Dr. Mapota concludes.