Medical Education

All About Medical Education

Medical Education.

Family Medicine Specialty Training Program

The Lesotho Ministry of Health and Social Welfare launched its Family Medicine Speciality Training Program (FMSTP) in January of 2008 with faculty from Boston University, the University of the Free State in South Africa and local physicians leading the training. This program is intended to recruit home many of the Basotho students studying medicine in South Africa, provide them with the training necessary to meet the health care needs of Lesotho and the motivation to improve the conditions of the health system, and provide career opportunities that will retain them.This is a central step in developing a long-term, sustainable system of care at the district level. Funding for the continued employment of faculty positions for this program after grant-funding ceases was approved by Cabinet in September 2006.

The Lesotho-Boston Health Alliance (LeBoHA) has partnered with the Lesotho Medical Association to identify priorities for Continuing Medical Education (CME) of physicians in Lesotho. This has included providing technical and administrative support to strengthen and expand the Lesotho Learning and Sharing Forum for physicians and other health providers. In order to bring the latest findings in health care to the health care community, we have also provided editing and publishing services to revitalize the tri-annual Lesotho Medical Association Journal, which is now being distributed to all physicians in the country.

Health Research and Evaluation

Baseline Study of Queen Elizabeth II Hospital

The study provided a comprehensive baseline study of the availability, quantity, and quality of services existing at Queen Elizabeth II hospital (the national referral hospital) and three associated filter clinics as well as volume and cost of cross-border referrals. This study has informed many elements of the 18-year contract negotiated with the Government of Lesotho for the operation of the new Public-Private Partnership hospital by Netcare Consortium. This baseline, periodically repeated, will also provide essential information for assessing the impact of the PPP hospital over time.

Baseline Needs Assessment with Cost & Utilization Study for Select Hospitals

The Lesotho Boston Health Alliance (LeBoHA) collected baseline data of district hospitals with specific focus on TY Hospital in Berea and Motebang Hospital in Leribe. The assessment aimed to:

  • collect both qualitative and quantitative data for the key indicators selected and identified in the proposal to the Ministry of Health and Social Welfare,
  • better understand the current levels of service delivery provided at the district level, and
  • begin the process of collaboration and staff development at the district level.
Baseline data was also collected for 6 other hospitals (Ntsekhe, Mafeteng, Scott, Mamohau, Paray, and St. James) for purposes of comparison and planning for later expansion to other districts.Our plan is for the collection, analysis, discussion and use of this type of data to become an integral part of district level operations and will not require the use of consultants from elsewhere in Lesotho. We have also begun to demonstrate that data is not something collected for some one else in some distant place, but rather it is what you collect to do your own job well.

Health System Policy Management

Financial Management Strengthening

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.

Hospital & DHMT Management Strengthening

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.

Quality Assurance

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%.

Strengthening District Hospitals and Health Centres

During his work with the Maternity Quality Improvement Project at Motebang Hospital, Dr Machai [an ex-second year registrar in the Family Medicine Specialty Training Program] became aware of the urgent need for improved care of high- risk prenatal patients in order to decrease pregnancy associated complications and the maternal mortality rate. He led the multidisciplinary QI committee in establishing criteria for high-risk women and gave a series of presentations to the hospital staff. As a result of these efforts the Maternal and Child Health nurses were trained in the identification of high-risk pregnancies and a mechanism was set up to refer these mothers to the appropriate Motebang physicians. Dr. Malope [an ex-third year registrar in the Family Medicine Specialty Training Program] gave a series of trainings in managing a complication of delivery – shoulder dystocia. He trained nurses on the maternity ward and at the Maputsoe filter clinic. The day after he trained the nurses at the filter clinic they delivered a woman with shoulder dystocia and managed her successfully. The nurses were excited about their skills and competency.