The problem of shortage is exacerbated by disproportionate distribution of health workers, with most health workers based in the lowlands and urban areas of the country at the expense of the rural and mountain areas. The lowlands and urban areas are better endowed in terms of essential services such as electricity, communication mechanisms, reliable transportation, accommodation, entertainment and enjoyment of social life. The inadequate distribution of the health workers against the rural and mountainous areas has a large and negative impact on people’s health, leading to preventable death and suffering.
According to the Lesotho Health System Assessment 2010, although more than 60 percent of health care is supplied at the Primary Health Care (PHC) level, less than 20 percent of the formal sector labour supply is employed at the PHC level, suggesting a poor distribution of the health workforce. The largest share of the formal sector labour force is employed at the secondary level (46 percent), and 24 percent are employed at the tertiary level. As a result, as of 2004, only 31 percent of filter clinics had the full-time equivalent personnel that they required, and only 41 percent of health centres met minimum staffing standards with respect to nursing personnel. Conversely, the national referral hospital had 108 percent of their full-time equivalent nursing requirements met, and district hospitals had 50 percent of their nursing requirement filled.
Staffing at all levels of the health system is inadequate, causing poor service delivery at community health centres, where PHC is essential. Poor service delivery distorts the referral system whereby patients that should obtain care at lower level facilities refer themselves to a higher level within the health system, rendering organization of services chaotic, impairing access to services and negatively affecting the quality of services offered.
The MOH provides a standard incentive package (M275/month) to employees assigned to the mountainous regions of the country. The amount has insignificant impact. In addition, certain cadres of staff (doctors) receive a sitting allowance when required to work over a specified number of hours. Development partners such as the Clinton Foundation are providing a top-up allowance to nurses working in ART clinics.