NATIONAL COMMUNITY BASED HEALTH STRATEGY (NCBHS)

1. BACKGROUND

Community health is gaining prominence in Lesotho and many other countries in Eastern and Southern Africa. At the core is the provision of primary health care services to rural and urban communities with full participation and ownership by the community. Community health is a critical component of Public Health, of which the main objective is to promote health and prevent diseases within families and at the community level, ensuring universal access to primary health care as close as possible to the population. Globally, community health is a critical contributor towards achievement of the Sustainable Development Goals (SDGs); in particular, SDG 3 on universal health coverage, alongside the attainment of other SDGs, including eradication of hunger, quality education, gender equality, clean water and sanitation, innovation and infrastructure, reduced inequities, and partnerships. Therefore, achieving these goals demands comprehensive approaches that focus on building a strong and responsive community health system. Over the years, community health has significantly contributed to improvements in health outcomes. However, neither has community health been institutionalized, nor community health worker cadre have been professionalized. Lesotho’s community health system faces resource constraints, inconsistencies around quality of service and weak coordination which have a negative impact on health outcomes.

The Lesotho Ministry of Health (MOH) is committed to advance the community health agenda, considering the impact of the COVID-19 pandemic and the recognition of the important role communities play in strengthening health systems, both as watchdogs and service providers. The MOH launched the Village Health Programme Policy in 2020. Nevertheless, its implementation has been erratic and limited for the document does not encompass broader community health services. The Community Based Health Services (CBHS) Programme has developed a Village Health Worker Tool Kit that contains a package of capacity building manuals, guidelines, standards, and other relevant documents for community-based health services. The country therefore requires a comprehensive national community health strategy that encapsulates the vision, values, policy directions, strategies, and implementation plan for the delivery of quality, integrated community health services. These services shall be affordable, appropriate, culturally acceptable, client-centred and accessible to every household through meaningful community participation, as outlined in the 2021 Essential Health Service Package and mandated in the MOH policy and strategic framework. Such a comprehensive strategy will respond to priority needs, challenges and expectations and define policy directions for each of the health system building blocks including community engagement, multi-sectoral collaboration, resource implications and an investment strategy.