Making appropriate healthcare services available to all Basotho, even in the far-flung rural areas, is a cornerstone of Lesotho’s Vision 2020 framework, and the focus in recent years has been on retaining skilled staff and building new facilities.
There are challenges to providing healthcare services in Lesotho, exacerbated by the lack of adequately qualified healthcare professionals and the country’s demographic and geographic profile. The mountainous terrain and isolation of many rural areas, where the vast majority of the country’s population resides, represents a significant access barrier to both staff and patients, and the World Health Organisation (WHO) estimates that around three-quarters of the rural population is outside of walking distance of a health facility.
Retaining health workers in the remote parts of the country is also problematic, and primary healthcare services in these locales experience chronic shortages of medical and allied health professionals. During 2013/14, the Ministry of Health (MoH) launched a retention programme for nurses and midwives working in rural areas, which has met with some success. Lesotho’s Government has also continued to train more medical doctors, and it was reported in the 2014/15 budget address that a third cohort of students had been sent to Zimbabwe and approximately 39 nurses sent for advanced midwifery training to address maternal mortality.
The old Queen Elizabeth II Hospital, which was closed because of its deteriorating physical condition, has been partially reopened for limited health services. While studies are being undertaken to design a district hospital to replace the QE II, Government is enhancing the capacity of satellite filter clinics in Maseru and surrounding areas to alleviate the patient load at the new Queen ‘Mamohato Memorial Hospital, which currently serves as both a national referral and district hospital.
Economic growth in Lesotho has been inhibited by unfavourable trends in morbidity and mortality, which have weakened the human resource base. High mortality rates have affected not just the labour force but the social fabric as well through growing numbers of orphans and deepening levels of poverty. Significant drivers of Lesotho’s poor health profile include high HIV/AIDS prevalence, limited access to essential healthcare such as maternal-child and preventive services, poor quality of services, and lack of essential drugs.
As reported in the WHO’s Country Cooperation Strategy for Lesotho (May 2014), many health indicators have remained static, while others have only registered minimal progress. The infant mortality rate improved slightly between 2005 and 2012 (from 84 per 1000 live births to 74 per 1000, respectively), while the under-five mortality rate has dropped from 108 to 100 per 1000 live births. The WHO lists common causes of under-five deaths as HIV/AIDS (19 percent), preterm (15 percent), asphyxia related to intra-partum events (14 percent), pneumonia (13 percent), sepsis/tetanus/meningitis/encephalitis (10 percent) and diarrhoea (7 percent).
The maternal mortality ratio is getting better, with an estimated 490 maternal deaths per 100 000 live births in 2013 from 670 per 100 000 in 2005 (UNICEF, 2014). However, as with infant and child mortality figures, it is still notably higher than neighbouring countries in the region: most likely related to the fact that only 58.7 percent of deliveries take place in healthcare facilities.
The 2009 Lesotho Demographic and Health Survey (LDHS) indicated that while 61.7 percent of children aged 12-23 months had received all basic vaccinations (down from 67.8 percent in 2004), the coverage for individual vaccines, ranging from 74.9 to 95.7 percent, was adequate to provide general immunity. According to Global Health Observatory data (April 2014) DTP3 immunisation coverage among one-year-olds was 83 percent in 2013. However, the WHO reports that measles coverage had dropped to 59 percent in the same year.
Chronic malnutrition remains one of the most serious long-term problems facing the country, with the WHO estimating that nearly half of under-five deaths are attributable to under-nutrition (2012). The 2009 LDHS report also revealed inadequacies in child nutrition, with 39.2 percent of children stunted (short relative to their age), 3.8 percent wasted (inadequate weight relative to height) and 13.2 percent underweight. There was also a high deficiency of micronutrients among children 6-59 months of some 47 percent. At 4 percent, diarrhoeal diseases are among the top ten diseases seen in outpatient departments (WHO, 2014).
Poverty and food insecurity in Lesotho are further fuelled by high HIV prevalence. UNAIDS estimates for 2013 indicate that between 350 000 and 380 000 Basotho are currently living with HIV, and that the prevalence rate is 22.9 percent for adults aged 15 to 49. Furthermore, around 36 000 children aged 14 and under have HIV, and there are 150 000 AIDS orphans in the 0-17 age bracket.
The Basotho people have also had to contend with a second epidemic, tuberculosis (TB), which spreads rapidly and is particularly deadly to an immune system already weakened by HIV. Lesotho has the fourth highest TB incidence in the world, estimated to be 630 per 100 000 of the population in 2012. Furthermore, some 80 percent of patients identified with TB are co-infected with HIV (PEPFAR, 2013).
Lesotho also faces an increasing burden of non-communicable diseases, with WHO and other surveys undertaken in 2012 showing the prevalence of hypertension at 31 percent and diabetes at 1.3 percent. In 2012, hypertension was among the top ten conditions seen in outpatient departments (9 percent), with stroke and heart failure responsible for 6 percent of deaths in males and 2 percent in females. Deaths due to diabetes accounted for 2 percent and 3 percent for males and females, respectively. Cervical cancer is the most common cancer in Lesotho, and the leading cause of cancer death among women in the country – particularly for women living with HIV, who are four times more likely to develop cervical cancer than women who are HIV-negative.
Lesotho continues to implement the public health interventions defined in the Essential Services Package: health education; environmental health; maternal and child health; implementation of IDSR strategy and the IHR (2005). As regards maternal and child health, the attendance by a skilled health worker during delivery has improved to 61.5 percent, while antenatal care coverage stands at 92.1 percent. Contraceptive use has increased to 47 percent. Access to antiretrovirals (ARVs) stands at 59 percent.
HEALTH POLICIES & PLANS
The National Health Sector Policy 2011 has been finalised and disseminated, while the National Health Strategic Plan 2013-2017 has been finalised and is awaiting printing. The National Health Policy and Strategic Plan are both harmonised and aligned with the NSDP and the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa. Officially launched in November 2013, the Primary Health Care Revitalisation Action Plan (2011-2017) seeks to promote the institutionalisation of primary healthcare and partnerships with communities, as well as strengthening the operational effectiveness of community health workers. The Ministry of Health (MoH) has embarked on the process of decentralising health services to the Ministry of Local Government and Chieftainship Affairs following the launch of the decentralisation process in December 2011.
A wide variety of development partners and donors support the Government of Lesotho in the health sector. Over the past decade, the WHO’s technical and financial support has consistently been a significant part of health sector expenditure. The private sector is diverse, ranging from modern facility-based state-of-the-art services to indigenous medical practitioners, pharmacists and non-qualified practitioners.
The Health Development Partners Forum, co-chaired by the WHO and the US President’s Emergency Plan for AIDS Relief (PEPFAR), facilitates coordination of health sector support in the country from the partners’ side. Harmonisation of donor support and alignment with national plans and strategies is essential for aid effectiveness, and a sector-wide approach (SWAp) mechanism is being worked on to strengthen the provision of technical and financial support as well as to foster mutual accountability of Government and partner organisations.
While the development community and donors remain committed to supporting the MoH and the Ministry of Social Development in its health development programmes, there is a need to improve both coordination and follow-up. The MoH requires assistance in playing the lead role in the coordination of partners as well as in targeting financial support.
The United Nations in Lesotho has completed the United Nations Development Framework and Plan (LUNDAP), which is fully aligned with the NSDP 2013-2017 and implemented through the ‘Delivering as One’ initiative. The first annual review of the LUNDAP was conducted jointly with Lesotho’s Government in February 2014.
Strategic priorities and focus areas under the WHO Country Cooperation Strategic Agenda (2014-2019) for Lesotho comprise: strengthening the prevention and control of HIV/AIDS, tuberculosis (TB) and MDR-TB; strengthening family and community health, including sexual and reproductive health; enhancing the capacity for the prevention and control of major communicable and non-communicable diseases; strengthening health systems capacities and performance; and fostering health sector partnerships, advocacy and equity.
Maternal and child health
UNICEF’s Lesotho Country Programme (2013-2017) is based on the NSDP 2013-2017, the United Nations Development Assistance Framework (UNDAF) 2013-2017, the Situation Analysis of Women and Children and the UNICEF Internal Strategic Moment of Reflection. The HIV and health programme component is being undertaken in collaboration with key line ministries, UN agencies and civil society organisations, and in line with the National HIV and AIDS Strategic Plan (2011/12-2015/16) and the Health Sector Policy (2012). The component is expected to achieve the following key results:
- By 2015, 95 percent coverage of quality Prevention of Mother-to-Child Transmission (PMTCT) and paediatric HIV care and treatment services to eliminate new infections among children and to keep those infected alive
- By 2017, 80 percent of young women and young men (10-24 years) with the knowledge and skills to protect themselves from HIV infection
- By 2017, contribution to national efforts to address deteriorating maternal and child health and nutrition statistics, access to high-impact health, nutrition and WASH (water, sanitation and hygiene) interventions increased by at least 10 percentage points in the four focus districts that have the worst child mortality and malnutrition rates
Approved during 2013, the World Bank’s Maternal and Newborn Health Performance-Based Financing Project for Lesotho runs until mid-2017 and is expected to cover an extended population of more than 1.2 million people over a period of four years. A total of US $16 million will go towards improving the utilisation and quality of maternal and newborn health (MNH) services in selected districts, especially those living in hard-to-reach areas with very limited access to good health services. In addition to its infrastructure component, the project also focuses training of health professionals and village health workers and improving monitoring and evaluation capacity. Health facilities and personnel will receive financial incentives to meet pre-agreed and independently verified results, and ‘remoteness bonuses’ will be offered for health facilities in particularly isolated areas.
In 2013 the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), with funding from the US Agency for International Development (USAID) and PEPFAR, helped the MoH to launch services at Lesotho’s first-ever organised cervical cancer screening and prevention facility, the Senkatana Centre of Excellence located in the Bots’abelo Hospital in Maseru. Senkatana now offers comprehensive gynaecological services, with an emphasis on cervical cancer screenings, diagnoses, pre-cancer treatment services, and referrals to facilities for cancer treatment.
It was reported in May 2014 that since opening in January 2013 the facility has screened more than 2 300 women, the majority of whom had never been screened for cervical cancer in the past. Given the delay in processing test results, most clients are screened using Visual Inspection with Acetic Acid (VIA), a cost-effective alternative whose results are immediately available. Because the centre provides a full range of services, clients are also offered breast exams, HIV testing and counselling for those who do not know their status, and screening for sexually transmitted infections (STIs). Other at-risk groups are also screened for diabetes and hypertension.
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer, with HPV types 16 and 18 responsible for about 70 percent of all cervical cancer cases worldwide. The immunisation of girls against HPV is viewed as the most cost effective method of managing the occurrence of cervical cancer, and Lesotho has implemented a number of vaccination campaigns over the past five years.
THE HIV/AIDS PANDEMIC
HIV and AIDS is an extraordinary threat to Lesotho’s development, as it hinders child and maternal health, undermines economic productivity and affects the educational outcomes of Orphans and Vulnerable Children (OVCs). Lesotho currently has the third highest HIV prevalence rate in the world. However, key indicators suggest that some progress is being made in reversing the spread of HIV. Both the prevalence rate among the youth (15-24 years) and the incidence rate have declined since 2004, driving a modest decrease in new infections.
Comprehensive studies have allowed the Lesotho Government and partners to identify the primary drivers of new infections and scale up more effective prevention strategies. The current challenge is to accelerate the implementation of evidence-informed, targeted prevention strategies focusing on multiple partnerships, correct and consistent condom use, youth sex education, circumcision, gender discrimination, key populations and migrant labourers.
With the National AIDS Strategic Plan (2006-2011) having run its course, Lesotho’s national, multi-sectoral HIV and AIDS response is presently guided by the National HIV and AIDS Strategic Plan 2011/12-2015/16. The new plan incorporates Lesotho’s universal access commitments under the 2011 Political Declaration on HIV/AIDS, as well as its MDGs. Essential aims of the plan are to:
- Accelerate and intensify HIV prevention to reduce new annual HIV infections by 50 percent
- Scale up universal access to comprehensive and quality-assured care, treatment and support
- Strengthen coping mechanisms for vulnerable individuals, groups and households
- Improve the efficiency and effectiveness of coordination of the national multi-sectoral HIV and AIDS response
The HIV and health component of UNICEF’s country programme 2013-2017 is discussed under ‘Maternal and child health’ above.
PEPFAR partnership framework
A partnership framework between the Lesotho Government and the US President’s Emergency Plan for AIDS Relief (PEPFAR) supports the implementation of the Lesotho National HIV and AIDS Response. The PEPFAR Operational Plan Report (2013) highlights the following programmes.
HIV Testing and Counselling (HTC): Existing Community-Based HTC programmes targeting men in transport corridors are currently identifying only 8 percent of those infected with HIV in the context of a national male prevalence of around 18 percent. Changes are thus being made to better target higher-risk men, including those with more education, incomplete primary education and the employed, through collaboration with construction companies and ‘professional’ workplaces in urban areas.
PEPFAR will also offer direct support to MoH sites for Provider-Initiated Testing and Counselling (PITC) services, placing counsellors at four district hospitals and at filter clinics for the tertiary referral hospital in Maseru. This site-based approach should dramatically increase the yield of positives identified while also linking them with care and treatment services.
Voluntary Medical Male Circumcision (VMMC): Evidence from international research, as well as the findings of the MoH situational analysis, has shown that male circumcision reduces transmission from a woman to a man by 60 percent. PEPFAR and UNAIDS estimate that scaling up VMMC to reach 80 percent of males aged 15 to 49 years in Lesotho over a five-year period (2012 to 2016) would avert more than 106 000 (36.6 percent) new adult infections by 2027. Given the potential of VMMC to change the course of the epidemic, PEPFAR Lesotho is rapidly expanding such services to all ten districts in Lesotho, while maintaining the MoH’s vision of integrated facility-based services. This involves extending services from eight to 16 sites, including three high-volume sites in Maseru.
Prevention of Mother-to-Child Transmission (PMTCT): Mother-to-child transmission is the leading cause of HIV infection in infants and young children. It is estimated that 62 percent of pregnant women living with HIV presently receive effective antiretroviral therapy (ART), compared with 38 percent in 2009, with cases of mother-to-child transmission of HIV/AIDS having dropped significantly as a result (WHO, 2014). The Strategic Plan for Elimination of Mother-to-Child Transmission of HIV and for Paediatric HIV Care and Treatment (2011-2016) aims to achieve zero vertical transmission of HIV by 2015.
In May 2013 the country began, with PEPFAR’s support, the transition to ‘Option B+’ – a simplified approach to PMTCT and treatment that offers all pregnant or breastfeeding women living with HIV lifelong ART, regardless of their CD4 count or clinical staging. This option not only reduces mother-to-child transmission of HIV to less than 5 percent, but also maintains the mother’s health, provides lifelong reduction of HIV transmission to uninfected sexual partners, and supports PMTCT in future pregnancies. PEPFAR is working to identify innovative approaches that can be implemented to ensure linkages to care and pre-ART health services, initiation on ART in antenatal clinics and maternal, neonatal and child health settings, and retention on ART in the post-natal period.
Antiretroviral Therapy (ART): There has been a tremendous increase in adult ART coverage, from 13 percent in 2005 to 59 percent in 2012 (UNDP, 2013). ART coverage for children has been increasing at a notably slower rate to reach 24 percent by 2012. In adult treatment, PEPFAR Lesotho is presently scaling up district and facility level quality improvement of services, with secondment of additional nurse clinicians to ART clinics in district hospitals. With regard to paediatric treatment, funds will support four additional paediatric HIV management satellite centres of excellence. As part of the drive to eliminate paediatric HIV, PEPFAR Lesotho also supports clinical cohorts for mother-baby pairs to monitor HIV free survival and the proportion of children still on treatment after 24 months.
Positive Health, Dignity and Prevention (PHDP): Activities focus on keeping People Living with HIV (PLHIV) physically and psychologically healthy, preventing transmission of HIV, and involving PLHIV in HIV prevention activities, programme design, implementation and monitoring, leadership and advocacy. Previous concerns around specifically targeting PLWHA due to increasing stigma have been ameliorated with improving legal protection and greater access to HIV services. With 50 percent of HIV infected Basotho in a sero-discordant relationship, the aim is to work through community-based PLWHA associations to deliver a package of services that includes condoms, risk reduction counselling, education and referral for support.
Protecting the youth
The HIV component of UNICEF’s Country Programme for Lesotho (2013-2017) encompasses HIV prevention, education and treatment services for the youth. With a focus on high-prevalence districts, it aims to equip young people, particularly adolescent girls, with information, skills and supportive services to protect themselves from HIV. This contributes to the scale up of quality adolescent health care, including HIV testing, counselling and referral, and supports adolescents living with HIV. The media, new technologies, and community-based structures, including youth groups, are being utilised to increase comprehensive knowledge and health-seeking practices for HIV prevention among young people.
The identification and management of TB and HIV co-infected individuals has improved significantly since 2009. Although the incidence of co-infection remained stable at 76 percent (with approximately 80 percent of new TB patients being tested for HIV), the proportion of those co-infected being enrolled on ART has increased substantially, from 24 percent in 2008 to 40 percent in 2012. This has occurred as a result of significant improvements in the diagnosis and management of co-infected patients. Revised national ART guidelines, which now recommend that all HIV-positive individuals with active TB infection be started on ART regardless of CD+ lymphocyte count, have also contributed to this improvement.
Elizabeth Glaser Paediatric Aids Foundation
Since 2004, the Elizabeth Glaser Paediatric Aids Foundation (EGPAF) has worked in partnership with Lesotho’s MoH, district health teams, health facilities, and communities. It presently supports more than 140 sites (65 percent of the country’s disease burden) to provide comprehensive HIV and TB services. TB is currently the second leading cause of death in Lesotho. As of 31 December 2013, EGPAF-supported programmes in Lesotho had:
- Provided PMTCT services to more than 167 000 women
- Enrolled more than 227 000 clients into HIV care and support programmes, including more than 16 500 children younger than 15
- Initiated more than 113 000 individuals on ART, including more than 6 500 children younger than 15
The health system in Lesotho consists of 22 hospitals and 192 health centres (clinics) administered by different bodies. Healthcare facilities are distributed throughout the country, with Government administering 12 hospital and 79 clinics, the Christian Health Organisation of Lesotho (CHAL) eight hospital and 75 clinics, Lesotho Red Cross Society (LRCS) four clinics and the Maseru City Council two clinics, with two hospitals and 33 clinics being privately owned.
CHAL has, through a memorandum of understanding with the Lesotho Government, reached an agreement to remove fees at clinic level and apply uniform tariffs in CHAL hospitals. Government in return pays CHAL salaries and compensates CHAL for basic healthcare services provided. A similar agreement was concluded with the LRCS at the end of 2009.
The Health Sector Programme of the Millennium Challenge Account (MCA) has been an important source of funding for Lesotho’s healthcare facilities. By 2013, this had seen the rehabilitation and expansion of 138 health centres across the country, expansion of 14 hospital outpatient departments, construction of a new laboratory and a new blood transfusion service centre, as well as dormitories for students and teachers at the National Health Training Centre (NHTC). The new National Laboratory and Blood Transfusion Centre based in Botšabelo, Maseru, aims to improve laboratory and diagnostic services to support the management of HIV/AIDS and nationwide TB programmes, as well as assure adequate and safe blood supplies for HIV/AIDS patients. Lesotho has received US $362 million through Millennium Challenge Compact funding channels since 2007.
Opened in October 2011, the Queen ‘Mamohato Memorial Hospital in Maseru is a state-of-the-art referral hospital named after the late Queen ‘Mamohato Bereng Seeiso. Accommodating 425 patients – 35 private and 390 in the general ward – and some 700 employees, the ultra-modern hospital was built through a Public-Private Partnership agreement. It replaces the Queen Elizabeth II Hospital, which was built more than half a century ago.
Serving 20 000 inpatients and 310 000 outpatients a year, Queen ‘Mamohato Memorial delivers significantly more services and services of a higher quality than its predecessor, offering magnetic resonance imaging, laparoscopy procedures, neurosurgery, pathology services, intensive-care facilities, and 24-hour obstetrics at filter clinics. According to a 2013 Boston University study, during 2012 the number of admissions increased by 51 percent, outpatient visits more than doubled, and the hospital and filter clinics assisted 75 percent more deliveries. Average length of stay for an inpatient admission was 16 percent lower than at QE II, indicating higher efficiency and throughput of patients. In addition, mortality and morbidity rates have been reduced, with death rates down by 41 percent, maternal death rates by 10 percent and paediatric pneumonia death rates by 65 percent.
The extension and refurbishment of Scott Hospital, the birth place of the King Letsie III, is currently underway. Phase one of the project, estimated at M15 million, covers the following components: 24-bed maternity ward and ten-bed labour ward, including six cot nursery units, four beds for lactating mothers and one feeding room; an 18-bed female general ward; 12-bed female TB ward; 4-bed MDR room and associated support facilities.
Lesotho’s other top hospitals include Maseru Private Hospital in Thetsane, and Wilies Hospital in Khubetsoana, Maseru. Additional health facilities in the Maseru area include Mohlomi Hospital for the Mentally Ill; Baylor College of Excellence, which caters for children with HIV/AIDS; Senkatana for the provision of ART to adults; and the NHTC, which trains nursing professionals.
Lesotho’s only military health institution, Makoanyane Military Hospital (MMH) was established in 1988 by the Lesotho Defence Force to provide health services for those in the military as well as their family members. Infrastructure development in recent years has seen the creation of various medical and non-medical departments, such as physiotherapy, laboratory, maternity ward extension and expansion of medical stores, as well as the creation of a Wellness Centre containing a TB clinic, hypertensive and diabetes clinic, mother and child health and family planning clinic and HIV/AIDS clinic.
The National Drug Service Organisation (NDSO) is a leading statutory body established as a trading account of the MoH, and is mandated to procure, store and distribute medicines and medical consumables for Government and other health institutions in Lesotho. The organisation is the largest distributer of pharmaceuticals and medical equipment in the country, and strives to make safe, effective, good quality and affordable medicines available to Lesotho’s public and private sectors.
Vision Clinic Optical Laboratory www.visionclinic.co.ls is a wholly Basotho owned and run surfacing and finishing laboratory for the optical industry. The use of cutting-edge technology, advanced surfacing equipment and edging machinery allows lenses to be manufactured locally, saving the time and cost of having to import these from a neighbouring country.
Founded in 1996, Sechaba Healthcare Lesotho (Pty) Ltd is the oldest and largest dedicated healthcare broker in Lesotho, with offices situated on the Ground Floor, Sechaba House, 4 Bowker Road, Maseru. Sechaba Healthcare is proud to have been instrumental in bringing private healthcare to the people of Lesotho, and its commitment has made a vast difference to the lives of Basotho over the past 18 years.
In addition to private individuals, Sechaba Healthcare services over 50 employer groups, with a member base of 3 000 principal members plus an additional dependant base of a further 4 000 lives, making it the largest medical scheme broker in Lesotho. The company’s continued growth and success comes as a result of its commitment to the local market, continued assistance in the development of better products, and knowledge and understanding of healthcare needs in Lesotho and the proximity of South Africa’s first world facilities.
Sechaba Healthcare has good relations with employer groups and members, and also with local and South African service providers, ensuring that the medical schemes offered give members excellent benefits along with affordability and sustainability. It also has a sister company called Risk Managers Lesotho (Pty) Ltd, which focuses on employee benefits, short term insurance and investment.
The lack of human resources for health is a critical limitation to the functioning of Lesotho’s health system. Effective health systems depend on a trained and motivated workforce that can carry out the tasks and build the systems needed. Defined as an HRH (Human Resources for Health) crisis country by the WHO, Lesotho has distinct challenges which place it at a disadvantage even when compared with other African countries. As a result, there is a high level of misdistribution of the health workforce within the country, with urban areas absorbing much of the labour pool.
The ratio of staffing to population (number of providers per 1 000 members of the population) in every major healthcare provider category is far below the African regional average of 2.262, standing at 0.850 (UNCTAD Services Policy Review, 2012). According to the WHO, recommended numbers of nurses/midwives and physicians are at least one doctor per 1 500 of the population and one nurse per 300 people. From this benchmark, Lesotho requires at least 500 more doctors (there are currently less than 200) to satisfy the minimum requirement; and with less than 4 000 nurses, the country needs a further 2 000 to make a total of 6 000 nurses.
The MoH has developed several policies and strategies in this regard, including the Human Resource Development Strategic Plan (2005-2025), which pays particular attention to pre-service training and increasing the nursing cadre. Lesotho is also preparing to open its first School of Medicine in partnership with the University of Zimbabwe, with PEPFAR Lesotho continuing to leverage support from the Medical Education Partnership Initiative. A policy dialogue to improve recruitment, deployment and retention mechanisms for critical health professionals has been initiated. The current focus is on continuing activities such as the Auxiliary Social Work training programme, and the Council for Higher Education will be supported in exercising oversight of health training institutions.