Lesotho was our first program, providing proof of concept that a program focused on a mindset shift, centred on country ownership, partner alignment, relevant didactic, and strong, ongoing mentorship can contribute to measurable health systems changes and health outcome improvements. The program was implemented in partnership with the Ministry of Health, USAID, EGPAF and Johnson & Johnson.
The PMTCT program was used as the tracer, with indicators monitored over the twelve month period. A multi-disciplinary team at the national level was set up to enhance supportive supervision at district level. An integrated supportive supervision tool was developed and used to enhance effectiveness of supervision. The national level team demonstrated visible leadership by participating in all review meetings and co-problem solving challenges highlighted by districts.
The program, through a focus on improving healthcare outcomes at district level, precipitated a critical policy change by the Ministry of Health regarding stock-outs. The period within which to recognize a stock-out changed from 30 days to 5 working days, which impacted positively on the availability of stock, and thus improved service delivery. Improvements were also realised in key program indicators such as first antenatal care attendance and proportion of women initiated on antiretroviral therapy. Timely submission of data by districts also improved.