February 17 - Lesotho/Geneva - Lesotho has become one of the first Low Middle Income Countries from the African region to be able to make a transition into self-financing, for the procurement of adult first line drugs for tuberculosis without further dependence on a grant from the Global Drug Facility.
The small mountainous country has been able to achieve this milestone because of political commitment at the highest levels and the intensive work by the staff in the program. This has been accomplished despite the heavy burden that both TB and HIV put on their health systems and budgets.
In a population of 1.8 million, in 2012, HIV/AIDS and tuberculosis (TB) constituted major public health problems where approximately 23% of the adult population is infected with HIV and 75% HIV co-infection among TB patients. In a country with such high HIV co-infection among TB patients proper management of drugs becomes complex and requires adequate training, skills and staff dedication, which became the cornerstones of the Lesotho TB control programme.
The government demonstrated its support for the initiative by committing 100% resources for the procurement of drugs from its national budget starting 2014. Full responsibility for TB drugs for adults will now rest with Lesotho as initially envisioned in 2008.
It began in 2007, when Lesotho received the first year of a 3-year grant from Stop TB’s Global drug Facility to buy first line drugs for adults. A year later in 2008, the Ministry of Health (MoH) committed to an increase of the governmental contribution to TB drugs corresponding to an additional 20% every year, though Direct Procurement with GDF which started in April 2009, to complement the grant support. GDF made consistent advocacy efforts during this period at all levels and provided technical assistance.
Not only funding for drugs, the MoH also demonstrated commitment to securing quality assured anti TB drugs through continued engagement of GDF and negotiations to obtain a waiver on open tendering, single source procurement and pre-payment. This allows the MoH to use direct procurement service and avoid open market thus minimising vulnerability to procuring drugs of questionable quality. The quality assured drugs supplied at internationally competitive prices and through WHO prequalified pharmaceutical ensures good treatment outcomes.
The health and TB services in the country include 10 administrative districts, 18 hospitals providing TB diagnosis and treatment services including quarterly reports on notification and treatment outcome, 216 health centers involved in patient diagnosis, initiation of treatment, implementation of DOTs and follow up of patients together with TB treatment supporters allocated to each TB patient,(or Community Health Worker). NTP operates a PPM through signed Memorandum (MOU) of Understanding with at least 18 private clinics to diagnose and treat TB patients free of charge since they are supplied with free first TB drugs and consumables such as sputum jars. NTP collaborates and coordinates a good number of partners including NGOs supporting TB, TB/HIV and MDR-TB services in public health services and private clinics. The country has proper TB drug management in terms of procurement of qualitative TB drugs through GDF, a pull system in place with buffer stock in all districts.
Lesotho has fourth highest TB incidence in the world estimated to be 630 per 100,000 populations and 900 MDR-TB cases cumulatively since programme inception in 2007 reported in 2012 (Ministry of Health Lesotho, 2012). At GNI per capita of $1380 in 2012, Lesotho ranks 157 out 192 on the HDI.
Source: Stop TB Partnership