The following is a response by Ministry of Health and Social Welfare to the article titled “Leribe Aids clinic faces uncertainty” published in last week’s Sunday Express. The article was originally published in the Globe and Mail newspaper of Canada.
MASERU — Leribe Hospital is one of the most accessible health centres in Lesotho.
There are normally at least four resident government doctors and a surgeon based at this hospital.
It is also a training site in internal medicine.
The government’s plan is to upgrade this hospital to a regional referral centre based on its accessibility and central location for the districts in the northern part of the country.
The Tšepong ART Clinic was established at Leribe Government Hospital, also referred to as Motebang Hospital, in 2004.
This was a result of the motivation by the then United Nations special envoy for Aids, Stephen Lewis, to the Ontario Hospital Association to assist Lesotho in the challenge it faced.
This support was opportune for the government of Lesotho.
Leribe Hospital was selected and became the first anti-retroviral treatment (ART) clinic in Lesotho.
The Ontario Hospital Association subsequently handed over the support to OHAfrica.
The government of Lesotho, through the Ministry of Health and Social Welfare, provided accommodation, transport, medical supplies and drugs including ARVs, and also covered operational costs and the “local” salary for one Canadian medical doctor.
The government also catered for the local human resources requirement for the functioning of the clinic.
Soon afterwards, with the support of other partners, additional ART clinics were opened and continue to be opened in public and church hospitals and clinics as well as at private health centres.
The government provides ARVs to all sites.
In addition, the government fully funds opportunistic infections treatment, other drugs and all the costs — including human resources, supplies and logistics — for such health facilities.
All the sites, including those operated with the support of other partners, follow government guidelines and protocols.
There are currently 185 ART sites in Lesotho treating more than 50 000 patients — and 3 500 of these are treated at Tšepong.
The local professionals deployed by the Ministry of Health to Tšepong are engaged either as government employees or through support to the government by partners such as GFATM and CHAL.
OHAfrica funded the ever-rotating Canadian teams and additional staff they unilaterally decided to employ.
These staff members continue to work at Tšepong.
The only exceptions are the staff that had been engaged unilaterally by OHAfrica for its own purposes — the majority are support and not professional staff with no direct role in patient care.
The government continues to fund all operations at Leribe Hospital including at Tšepong.
The history of the Ministry of Health’s partnership with OHAfrica is that of a cordial relationship although with challenges that the parties always endeavoured to resolve.
Up to four memoranda of understanding (MOUs) were signed during the life of the support.
Throughout the period of the MOUs the pivotal role of OHAfrica has always been capacity building for Lesotho.
It is noteworthy that the revision of the MOUs often coincided with the change of leadership of OHAfrica.
The Ministry of Health several times indicated to the local and Canada-based management of OHAfrica the slow roll-out of treatment, and that the programme ran parallel to the system and should be re-aligned.
OHAfrica not only had a change of leadership but there was a constant inflow and outflow of the Canadian expertise and staff.
In February 2009, in the discussions with the then chief executive officer of OHAfrica, both parties acknowledged that the implementation of the MOU did not build capacity to the ministry despite that being specified in the MOU.
The ministry communicated a strategy for capacity building at district and programmatic level.
OHAfrica promised to get back to the ministry on the way forward, but there is no indication to date.
The project leader left immediately after, resulting in the non-implementation of the request.
In October 2009, the ministry again indicated its dissatisfaction with the performance of OHAfrica, specifically relating to the expanded access for patients in the district to care.
Local clinicians at Tšepong indicated dissatisfaction with the relationship that existed between themselves and the Lerible Aids clinic still accessible
Canadians and the way patients were managed (own protocols, clinical research etc).
Tšepong has never reported on its performance utilising the set tools that are used by all sites.
They were more concerned with capturing the data the way they wanted and for their own use.
The 3 500 patients treated are therefore not backed up with the requisite data repository at the Ministry of Health.
The frequent changes in the organisational structure demonstrate the instability of the organisation and poor organisational capacity that impacted on project implementation.
The large number of Canadian staff in Lesotho was not really necessary.
It resulted in the high frequency of rotation and therefore worked against the sustainability of the programme.
OHAfrica at no time involved and trained professionals at Motebang.
The unit functioned vertical to its parent. This arrangement benefitted the experts more than Basotho.
The capacity of the local staff continues to be built through Ministry of Health-led mentoring and other modes of continuing education.
With reference to patients dying and resistance spread to South Africa, there is no scientific or other evidence in support of the allegation.
Patients continue to receive treatment from the staff that have been at the clinic, utilising the drugs — including second line where necessary — supplied by the government of Lesotho.
Population mobility between South Africa and Lesotho is historical and occurs across all borders.
The bilateral agreement between the two countries facilitates, as far as feasible, continuity of care and co-operation in communicable and other disease control.
The rationale for assuming increased mobility, especially of patients, due to OHAfrica’s departure, is therefore completely unfounded.
Patients and Basotho at large move across the borders all the time.
It is well recognised that even in the best of settings resistance to first-line ARVs will occur and should be monitored.
Lesotho’s guidelines include monitoring of the resistance.
At the same time the government provides second-line drugs when there is convincing evidence of resistance and not just challenges with compliance.
The patients at Tšepong continue to receive follow-up and adherence as well as other counselling support.
It is unwarranted to assume that with everything continuing other than the departure of OHAfrica, patients will now not be adequately cared for and monitored and hence develop resistance.
Given the apparent non-compliance of the clinic management and staff to the local systems, it may be that the doctor quoted in the newspaper article, Dr Philip Berger, who was in Lesotho as late as December 2009, had probably not taken time to learn of Lesotho and the established care and support systems.
It may be assumed he is not aware that the bulk of the OHAfrica funding served the organisation and very little was directly spent on Lesotho.
The only thing that will have changed by April this year is that there will not be any OHAfrica-aligned staff rotating at Tšepong.
In the last meeting between the Ministry of Health and OHAfrica leadership that included the latter’s current CEO, Mr Campbell, and a board member, held in Maseru and subsequently in Leribe, both parties agreed that capacity in ART had been built the ministry will fully take over the operations at Tšepong under the hospital management.
The agreement included that the ministry would absorb the warranted professional staff while OHAfrica would give notice to its own local staff of the termination of their employment.
The patients whom OHAfrica had been giving food rations would be assessed through the government’s social welfare system for their eligibility for indigent support.
The ministry requested OHAfrica to indicate its other area of comparative advantage for collaboration.
The ministry had earlier requested support and re-iterated the suggestion for supporting a centre of excellence close to or as part of the referral hospital.
The CEO agreed to this and promised to send a response.
The ministry is yet to receive a response and therefore has continued to seek support for the centre from other organisations including those based in Canada.
The hostile and unprofessional statements made to the papers are therefore a shock to the government of Lesotho.
We acknowledge the expertise of the doctors that rotated at Tšepong in Aids medicine.
We appreciate and are thankful for the time they took from their busy schedule to assist and support Lesotho.
We are reassured that their being to Lesotho has been of mutual benefit.
Canadian professionals and other support will continue to be welcomed in Lesotho.
The government also acknowledges the support by OHAfrica and wishes them well – we are confident that the partnership benefitted both parties.
We urge all concerned to therefore concentrate on invigorating efforts, directly or indirectly, at contributing positively to the control of HIV and Aids care for Basotho, thus ensuring a future for the kingdom.