MASERU – Lesotho’s slim total of four recorded COVID-19 cases, of which two have recovered, is grossly misleading for the authorities’ state of preparedness, a nurses’ association’s joint survey with a rights body has revealed. Acute lack of Personal Protective Equipment (PPE) for most frontline service providers is glaring, despite the numerous donations the country has received from local and international donors.
Decrepit infrastructure, a disorganised national healthcare system and insufficient empathic leadership aggravate the nation’s state of preparedness to fight a COVID-19 outbreak. These fissures in the health system emerged as part of the findings by a joint Lesotho Nursing Association (LNA) and Transformation Resource Centre (TRC) fact-finding mission from an outreach assessment to establish the preparedness of the country to fight COVID-19.
The two institutions claim Lesotho does not have a responsive institutional mechanism and does not show concerted efforts to protect healthcare workers and professionals’ rights. They further found out that the country does not provide for efficient delivery of quality health services at local communities, sub–national and national levels and that there is no commitment among senior health ministry officials and decision makers to improve working conditions and strengthen correlation of the health systems in place.
The two bodies further found out that from the establishment of a COVID-19 National Emergency Command Centre (NECC) and inception of response measures, activities have always been characterised by controversy ranging from procurement processes to mysterious disappearances of PPE donated by both local and foreign donors. They also expressed concern there were no measures applied to hold those responsible for the mysterious disappearances of the PPE accountable, adding that COVID–19 has not only brought this nation to its knees but also exposed its political leadership’s ignorance in appreciating the magnitude of medical predicaments and prevention responsibilities.
LNA General Secretary, ’Mamoneka Mokhisi, speaking on behalf of the two institutions, noted health centres around the country were not sufficiently equipped to fight COVID-19 “as they have been hit by the scarcity of PPE, absence of some facilities and amenities, lack of responsiveness of district emergency command centres and unacceptable working conditions for healthcare workers and professionals who are at the forefront of this war against this deadly disease.”
She said the most worrying was the inadequate supply of PPE in many health centres and complete lack thereof in others. “This PPE includes but is not limited to gowns, overall suits, face shields, surgical masks and N95 masks, sanitizers and infra red thermometers.
This PPE is of paramount significance in that it is utilised largely to minimise prospects of cross-infection in the process of uncovering a suspected patient and to protect healthcare workers from possible infection and ultimately, the nation at large as most of the nurses serve a large number of Basotho in their designated catchment areas,” she said. She added that the majority of health centres supervised by health organizsation, Partners in Health, have PPE in limited quantities “while in others there is absolutely none.”
According to her, approximately 70 percent of health centres visited lacked the necessary facilities and amenities to handle possible suspects. She said most of the centres do not have appropriate facilities for efficient screening and subsequent isolation of the identified suspects which include structures for screening suitable for all weather conditions and isolation centres.
She noted the majority of primary health centres in the country have inadequate running water supply and depend on rainwater harvesting through use of buckets. This is in addition to inefficient electricity and heating systems as their electricity is only limited to lighting and cellphone charging. Mokhisi said the heating system in some of the health centres was a serious challenge in the absence of gas heaters.
“Due to the procurement of amenities like heaters and gas cylinders being highly centralised under the District Health Management Teams (DHMTs), the healthcare workers and professionals’ working conditions have insurmountable woes which are particularly typical of clinics located in hard-to-reach communities,” she noted. She further highlighted the fact that nurses often went beyond the call of duty, which sometimes exposes them to fatal risks that include attending to COVID-19 suspects in the villages without proper PPE – while also not being paid risk allowances.
She said the majority of healthcare centres were understaffed, resulting in nurses working long, strenuous hours despite being expected to also be on call for night duties. Mokhisi further noted the health system in the country was plagued by a lot of problems and that the COVID-19 outbreak has only worsened an already fragile situation. Therefore, she said, they urgently recommended for the District Emergency Command Centre (DECC) and the District Health Management Teams (DHMT) to be audited. The institutions also recommend that both DECCs and DHMTs be called to order immediately to instill accountability for use of state funds.
“PPE needs to be dispensed urgently, efficiently and continuously along with proper COVID-19 management training in the appropriate context of the populace in designated regions of the country. Most importantly, nurses should be remunerated accordingly. “Their unpaid allowances and somewhat haphazard dispensation, unjust entry level of payment, disparity in remuneration because they are employed by different employers along with failure to observe their working environment is a ticking time bomb to the health of the many Basotho at large,” they recommended.