Guillaume Jouquet

After an initial period of three years in Lesotho, MSF has decided to extend its presence in the country for two more years and to launch a second phase of the project primarily focused on intensifying the transfer of responsibility for the programme to local health authorities and partners. This is due partly to the administrative process now underway in Lesotho to decentralise to local government, coupled with related health sector reforms, which have divided the former catchment area of Scott Hospital Health Service Area into two districts with different management structures. In each district there is a district health management team (DHMT), which is responsible for supervising primary health care. In Maseru district, the Scott Hospital PHC team is part of the DHMT and has been formally delegated responsibility for continuing PHC supervision in the five clinics formerly in Scott Hospital HAS (a sixth clinic, Kena, was re-zoned to be included in Maseru district in April 2009). The future management of PHC in Mafeteng is less clear. Therefore, a two-track process for handing over the MSF-supported programme has been established, with a faster track for the five clinics in Maseru district (by late 2009) and a slower track for the nine clinics in Mafeteng district, plus Scott Hospital (by late 2010).