LESOTHO

LESOTHO. Lesotho National Population Policy, June 1994. (Lesotho National Population Policy, Lesotho, Government of Lesotho, Ministry of Economic Planning, Population and Manpower Division, June 1994, 23 p.)

Demographic Scenario

The population of Lesotho estimated to be about 1.88 million as of mid 1991 is growing at the rate of 2.6 percent per annum. Due to inadequate fertility control measures and health services, especially in the rural areas, this rate of growth has remained more or less constant during the last five years. If this rate of population growth continues, the population of Lesotho will double in the next twenty-seven years putting much pressure on existing land space of 30,350 square kilometers of which only 9.0 percent is arable where most of the population concentrate both for habitation and agriculture. At present, population density on the arable land is about 700 persons per sq. km. as compared to 443 persons in 1976. Such a phenomenal increase in human numbers in such a short time has considerably attenuated the arable land-man ratio. Unless more land is brought under cultivation at the cost of huge investment, which is again very difficult to ensure under the prevailing economic situation, it will be difficult to support the increasing population. Apart from this, another disturbing aspect is the tremendous potentials built in the age-structure of the population. Population below the age of 15 years is 41 percent and those above sixty years are 7.4 percent. A country having such a high dependency ratio is bound to face difficulty to improve its economy by way of allocating more resources for investment in productive sectors and creating employment, while most immediate responsibility is to support people with basic necessities of life, like food, education, housing etc. Women of child bearing age (15 - 49 years) represent 45.6 percent of the total female population implying that unless adequate fertility control measures are taken, there shall be more than seventy thousand newborn annually. At present, 14.0 percent population are below 5 years requiring health facilities, and inadequate health facilities are already creating a great concern in the country as a whole.

Of the three levers of population growth, impact of migration on it is trivial. [The] death rate has declined to the level of 12 per 1,000 population, but [the] birth rate continues to remain high - almost 38 births per 1000 population. If fertility control measures continue to remain inadequate, this rate may increase further to aggravate the existing high rate of population growth.

Implications of Population Growth

If the current rate of population growth (2.6%) continues, [the] population of Lesotho will double in less than three decades. As a result, there will be several adverse consequences on society and economy. First, population below fifteen years continue to be somewhere between 45-46 percent of total population and thus, the potential for future growth will increase. Secondly, as more and more young people enter into [the] labour force, [the] existing unemployment rate of 35.0 percent will further aggravate and the unemployed people in absolute number will be staggering. Such a situation may create immense social and political unrest. Added to this, another emerging problem is the growing number of returning migrant workers from South Africa. In 1986, about 165,000 workers were there. This figure has reportedly come down to about 125,000 which is quite likely to dwindle further in the years ahead. These are the people whose remittances are the major source of Government revenues. As a result, not only [the] unemployment problem will aggravate, but also the country is going to lose a major source of its income.

Thirdly, there will be a tremendous demand for social services like health and education. The existing number of 182 health centers, 171 secondary schools and 1,181 primary schools needs to be doubled, simply to maintain [the] current level of health and educational facilities, but the resources needed for these will be enormous, rendering it difficult for the Government to ensure under [the] prevailing economic situation. Furthermore, quality of services will deteriorate. The existing doctor-population ratio of 1:14,280 will not improve nor the coverage rate of [the] population by other health providers like workers, nurses and so on. In a country where environmental degradation owing to land erosion and drought is a constant threat, and malnutrition among the poor families is endemic, overall status of health is quite likely to deteriorate, rather than improve, resulting in a high rate of morbidity and mortality. In the educational front, one can see a similar dismal scenario. At present, in primary and secondary schools, teacher-student ratios are respectively 1:56 and 1:21. This situation is bound to deteriorate, if needed resources to appoint more teachers and build up more schools commensurate with the growing number of school age population cannot be provided. Whatever progress so far [has been] achieved in education sector cannot be sustained; rather it will deteriorate. Per capita educational expenditure will diminish, and thus, quality of education cannot be ensured.

Fourthly, household possession of real assets like cows, goats and sheep is somewhat decreasing since 1987-88. Due to drought, grazing opportunities are also dwindling; and coupled with this, [the] rate of slaughtering is also increasing to feed the growing population. As a result, per capita availability of these assets will further deplete year after year with the increase in population. Fifthly, Lesotho once a food surplus country, has now turned into a food-deficit area. Due to bad weather and other factors, food production of maize was 137,227 metric tons in 1988-89 compared to 159,726 in 1987-88. Since then, it has been decreasing. As a result, [the] Government's import of foodstuffs has been increasing. Besides, due to increase in population, per capita availability of food has decreased, resulting in poor nutritional intake among a significant fraction of its population. In fact, in Lesotho, food production cannot keep pace with the rate at which population is increasing and as long as this situation will continue, per capita availability of food is bound to decrease.

Sixthly, urban areas are presently estimated to be growing at the rate of 5.5 percent with the exception of Maseru where the rate is higher than this. Reportedly, about 10,000 inhabitants are added to the existing urban population resulting in severe shortage of housing. Under the present rate of population growth, on the average, 6,000 new houses will be needed per year during the current plan period. This figure may rise, when rural - urban migrants will increase significantly in the next two decades. If [the] current rate of urbanization continues, Maseru alone will require 18,000 additional housing units by 1996 which is about 60.0 percent of the total housing requirements for the urban areas as a whole. Lastly, rate of overall economic growth is likely to decrease significantly as a result of the increase in population size. At present, per capita gross national income (GNP) is estimated to be US $ 490. If the current level of investment is not increased significantly commensurate with the increase in population size, national income will not increase. Even if the Government succeeds in raising the investment level to generate more income and savings, the net effect will be neutralized by [the] sheer proliferation of human numbers. Consequently, both gross domestic product (GDP) and gross national product (GNP) per person will deplete. Perhaps even the current level of progress cannot be sustained, if over time the current rate of population growth remains constant.

In view of the adverse consequences of [the] slow decline in fertility and resultant increase in the rate of population growth and size, the government of Lesotho has no other alternative but to make serious efforts to bring down the existing total fertility rate of 5.4 to 2.2 in 2011 AD through a series of policy and programmatic measures.

Programme Efforts So Far

In Lesotho, fertility control measures are still at the formative stage. In the Fourth Five Year Plan 1986 - 91, a modest beginning was made by undertaking some projects relating to maternal and child health and family planning, information, education and motivation, population education, national census and demographic training in the National University of Lesotho and strengthening [the] population and manpower planning unit in the Ministry of Planning. Many of the projects during the Fourth Five Year Plan could not start in time, and are now spilled over to the Fifth Five Year Plan. Family planning and MCH service facilities are so meager that only a small fraction of women are protected from unwanted birth. Several important agencies, particularly those that deal with women and youth, are yet to be utilized for population activities. One important undertaking of this period was [the] 1986 population census, but its detailed analytical report is still to be available. Other important surveys done were [the] household budget survey and labour force survey. But no efforts were made for evaluation of existing projects and programmes nor was any demographic survey on fertility, mortality and migration conducted during this period. As a result, some basic information on contraceptive prevalence rate (CPR), method mix, fertility and mortality rates is yet not available.

Demographic Goal

Within the framework of a long term demographic goal of achieving [a] net reproduction rate of one by 2011 AD, the objective of the Fifth Five Year Plan is set at bringing down the rate of population growth from the existing level of 2.6 percent to 2.3 by mid 1996. The operational implication of this is that [the] existing crude birth rate (CBR) of 38 per 1000 population shall have to be brought down to 34 per 1,000 population by providing family planning services to all eligible women of child bearing age so as to avert 35,183 births during the plan period in addition to births that would be prevented under the current level of fertility decline. It is assumed that [the] mortality level has already come to a stage where substantial decline would be difficult unless existing health facilities are augmented twice the present level. Given the current economic constraint, such a possibility seems to be remote. Fertility decline is assumed to be substantial as there is a potential scope to cover a larger number of couples with expanding family planning and MCH facilities through clinics and outreach workers. Tables I and II provide three demographic scenarios under three different fertility assumptions -- constant, moderate and substantial decline. It may be noted that a decline in mortality over the next five years is assumed to be moderate and common for three scenarios. In scenario I which assumes constant fertility over the plan period (i.e. CBR 38/1000 population), [the] rate of population growth will increase up to 2.7 percent in 1996. Scenario II, which assumes moderate decline in fertility (i.e. average decline of 0.5 in current level of CBR of 38 per 1000 population), will yield a rate of population growth up to 2.45 percent in 1996. In view of the high priority attached to population planning by the Government, such a slow pace of decline in fertility will, in no way, significantly contribute to achieving the long term demographic goal of NRR-1 by 2011 AD. Given the importance, Government could pursue a policy of drastic decline in fertility (i.e. reducing on average 1.0 birth per year from [the] current level of 38/1000 population), but [given the] existing support-facilities such as doctors, clinics, workers etc., and level of family planning knowledge in the rural areas, such a demographic objective seems to be unachievable in the short run. Under the circumstances, the path which the Government is inclined to pursue is the substantial decline in fertility (i.e. reduction of CBR by 0.8 per year) so as to reduce the rate of growth up to 2.3 percent from [the] 1991 level of 2.6 percent and that contraceptive prevalence rate shall have to be raised from [the] 1991 level of 18.5 percent to 31.0 percent in 1996. Table I provides the annual breakdown of the rate of decline of both CBR and CDR during the Fifth Five Year Plan (1991-96) under the assumptions of constant and moderate decline in fertility; while Table II provides the annual breakdown of the rate of decline in CBR and CDR under the assumption of substantial decline in fertility along with the birth prevention and contraceptive prevalence rate target during the plan period (1991-96). In order to achieve the long term demographic goal of NRR-1 as mentioned above, efforts must be made to raise the CPR level up to 70-75 percent by the year 2011.

TABLE I: PROJECTED POPULATION SIZE, AND RATE OF GROWTH DURING FIFTH FIVE YEAR PLAN, 1991-1996 UNDER THE ASSUMPTIONS OF CONSTANT AND MODERATE DECLINE IN FERTILITY

Population

Population size under

size under moderate

constant decline

fertility of fertility

Year Population CBR CDR RNI Population CBR CDR RNI

(000) (000) (00) (000) (000) (00)

1991 1885000 38.0 12.0 2.60 1885000 38.0 12.0 2.60

1992 1934010 38.0 11.8 2.62 1933444 37.5 11.8 2.57

1993 1984681 38.0 11.6 2.64 1982553 37.0 11.6 2.54

1994 2037076 38.0 11.4 2.61 2032315 36.5 11.4 2.51

1995 2091262 38.0 11.2 2.68 2082716 36.0 11.2 2.48

1996 2147308 38.0 11.0 2.70 2133742 35.5 11.0 2.45

TABLE II. PROJECTED POPULATION SIZE, RATE OF GROWTH, BIRTHS TO BE AVERTED AND CONTRACEPTIVE PREVALENCE RATE (CPR) DURING FIFTH FIVE YEAR PLAN, 1991-1996, UNDER THE ASSUMPTION OF SUBSTANTIAL DECLINE IN FERTILITY.

Year Population CBR CDR RNI Number of births* CPR

('000) ('000) ('00) to be averted (%)

1991 1885000 38.0 12.0 2.60 - 18.5

1992 1932879 37.2 11.8 2.54 3370 21.0

1993 1980814 36.4 11.6 2.48 5061 23.5

1994 2028750 35.6 11.4 2.42 6891 26.0

1995 2076628 34.8 11.2 2.36 8868 28.5

1996 2124390 34.0 11.0 2.30 10,993 31.0

TOTAL - - - - 35,183 -

CBR = Crude Birth Rate.

CDR = Crude Death Rate.

RNI = Rate of Natural Increase.

(*These are additional birth preventions on top of what will decline under the constant fertility assumption.)

Other demographic targets include a reduction of infant mortality rate from over 85 to 70 per 1000 live births and child mortality rate (aged 1-4 years) from 40 to 30 by mid 1996. In order to achieve these targets, coverage rate of expanded programme of immunization (EPI) of children under two years has to be raised up to 95 percent from the 1991 level of 60 - 65 percent.

Programme Strategies

In order to achieve [the] above demographic objective during the fifth five year plan (1991 - 96), the following programme strategies will be undertaken.

i) Family Planning services should be provided as an integral part of health services at all levels of service outlets. For this, [the] existing worker-population ratio as well as population-clinic ratio should improve by, at least, ten percent.

ii) Existing hospitals and clinics should be equipped with all clinical facilities for IUD, sterilization and injectables.

iii) Proper storage facilities of contraceptives and medicine should be ensured, at least, at the district level.

iv) A wide range of contraceptive services should be provided so that people can choose their own method.

v) Information, education and communication programme should be reinforced with appropriate messages through interpersonal communication and mass media including the use of video, mobile cinema van, radio and television.

vi) Existing women's programmes should be strengthened and [the] number of centers for skill training and population education should be increased, and women exposed in trade-skills should be given credit on soft term so that they can raise their income and contribute to household economy. They can also work as agents for family planning and MCH in their respective communit[ies].

vii) [The] training programme for field workers should improve. It may be revised to incorporate MCH and population components. If necessary, more instructors may be engaged at the National Health Training Center.

viii) Population education will be introduced in [the] formal school system from grade 4 through 12. [The] demographic training programme at the National University of Lesotho will continue. More and more population-related workshops will be organized by the relevant agencies to provide better understanding of population dynamics.

ix) In order to create a cadre of qualified manpower to meet the needs of population sector activities, several functionaries will be sent abroad for graduate studies from the Ministries of Planning, Health, Education, Bureau of Statistics, Home Affairs, Agriculture etc.

x) Department of Economic Policy will be strengthened with necessary manpower to effectively plan, coordinate and monitor all population projects of the country. Population projects, now dealt with in the other branch of the Ministry of Planning, will be brought under its purview. Besides, it should be responsible for coordination with donor agencies for all population-related assistance.

xi) Bureau of Statistics will be strengthened to start decennial census for 1996 in time. [The] Government will also take necessary initiative to undertake some programme evaluation research and demographic studies on fertility, mortality and migration.

Contraceptive Services and Quality Control

The Government will continue to provide a wide range of contraceptives so that the acceptors may choose the method they like best. These methods are: condom, oral pill, IUD, sterilization, and injectable. [The] Ministry of Health will continue to arrange training for all doctors and nurses in the Health Centers on sterilization and IUD insertion in a phased manner. Supervision and monitoring will be reinforced at all levels. Before allowing doctors and nurses to do sterilization and IUD insertion, as the case may be, some practical training shall have to be ensured. Proper counselling at the clinic, supported by follow up services at the household level for IUD and sterilization acceptors, will also be ensured.

Establishment of Model MCH - FP Clinic

[The] existing MCH-FP clinic at the Queen Elizabeth II hospital needs complete remodelling in order to upgrade it to provide improved services. Its physical space is too small to accommodate the increasing number of patients. It is also grossly understaffed in terms of doctors, nurses and support personnel, neither is it properly equipped and furnished. Its upgrading, therefore, includes construction of a new building, more professional and support personnel; better equipping and furnishing for which necessary funds will be provided. It will be an integral part of the Queen Elizabeth II hospital and will provide training to doctors and nurses of all district hospitals in sterilization and IUD insertion as well as in treatment of complicated cases.

Integration of Population Variables in Development Plan

Population has been traditionally perceived as [a] demand variable rather than as a factor that can affect socio-economic development. Many of the development plans do not even take into account population size and age structure while making decision[s] about resource allocation to various sectoral populations. In fact, population issues should be set forth as demographic problems (e.g. high rate of population growth, high fertility, high infant child and maternal mortality, low age at marriage, low level of contraceptive practice etc.) and also, as development constraints imposed by demographic factors. Unfavourable linkages which now exist between population, environment and development factors in Lesotho need to be appropriately reflected along with implications of population growth on sectoral activities. Besides role, status and importance of participation of women in development activities that are mainly designed for people's welfare needs to be stated in all public policy documents. In view of the serious population problem that Lesotho is facing today and shall face more severely in the foreseeable future, it is all the more important that Government's entire development should be tilted towards integrat[ing] population factors. In order to facilitate this operation, several areas are identified. First, the macro chapter of the five year development plan should envisage population size, rate of growth, and other demographic objectives along with the development goals and objectives. Secondly, as an integral part of [the] five year development plan, population planning envisaging both short and long term demographic goals, target of contraceptive users to achieve demographic objective as well as its linkages with other sectors of the economy in terms of implications as has been done in the present document. And lastly, in several sectoral plans, such as Health, Education, Environment, Women and Youth, Rural Development, Agriculture, Housing etc., data generated from population projections and specialised sectoral projections should be utilised, while setting sectoral targets, formulating strategies and estimating resource requirements. Such a planning approach will ensure population development integration.

Social Measures

Reduction in the rate of growth has been faster in societies having [a] conducive environment created through a series of social measures in favour of women's participation in development activities, wider opportunities of employment for youth, promoting female education and vocational training, maternal and child health benefits, enhanced investment for educational opportunities and so on. Keeping in view Lesotho's high rate of population growth, and its social and cultural milieu, several social measures are suggested below for creating an enabling environment for poising the society in favour of small family norm. These are:

i) Creation of enhanced opportunities for women specially in the rural areas through functional literacy and vocational training so as to enable them to participate in income-generating activities;

ii) Provision for equal access for both men and women to credit facilities for small scale production enterprise without collateral by creating special social groups, such as, mothers' centres, producers' cooperatives, model farmers' associations and so on. For this, any existing law that is, hitherto, unconcerned about this, needs to be modified to create an enabling environment;

iii) Population education and training should be provided as an integral component of training programmes of various Ministries to keep the participants informed of the consequences of rapid population growth on their sectoral outputs and investment plan. A necessary directive in this regard should be given from the highest level of the Government;

iv) The right to provide pension benefits should be guaranteed to all working women from the date of entry into service. Such a provision will uphold women's rights to equality in service and enhance their security and [self-] determination including their right to choose their family size,

v) Social marketing of contraceptives and informed choices for these should be ensured through all culturally acceptable media and institutional arrangements; and,

vi) Provision for social security to childless parents after the age of fifty-five. Necessary treatment should be provided to couples having no child even [after] several years of their marital union. Such treatment and diagnostic facilities should be made free by state law. Besides, Government should also consider providing free educational facilities to the poor parents having only one child.

If the above social measures are considered after careful examination along with proper implementation of MCH based family planning services, societal appreciation of population policy is expected to be very high and, thus, an enabling environment for the decline of fertility and mortality rate in Lesotho can be ensured.

Role of Ministries in Population Activities

Outlined below is the role expected to be played by different ministries and agencies during the Fifth Five Year Plan.

i) [The] Ministry of Health shall be responsible for family planning and MCH service delivery through its existing and potential service outlets like health centers, clinics, and field workers as an integral part of health activities. It shall also be responsible for those services related to procurement, logistics and supplies as well as distribution to the client level.

ii) [The] Ministry of Education shall be responsible for introduction of population education in their formal school system from four[th] to twelfth grades and continue to provide demographic training at the National University of Lesotho. It shall all impart skills training through vocational training centres.

iii) [The] Ministry of Agriculture shall introduce population education in its training institute and college. It shall make efforts to motivate [the] farm population on [the] small family norm through its extension workers. It should also organize women's cooperatives and provide credit on soft-terms and conditions to women with entrepreneurial skills for productive work.

iv) [The] Ministry of Information shall inform the people through television and radio by using appropriate themes and messages on [the] population problem, family planning [and] maternal and child health to heighten their motivation in favour of family size limitation.

v) [The] Ministry of Home Affairs should develop special programmes for the training of the District Secretaries and Village chiefs for arousing their interest in population activities and thus, enabling them to assume greater responsibility in population control in their respective spheres. It will also effectively implement the existing vital registration system.

vi) [The] Ministry of Planning shall be responsible for formulating population policy, integration of population variables in the relevant sectoral policies and programmes, as well as coordination of and resource allocation to various projects and programmes of the concerned ministries. It shall also be responsible for assessing programme impact through evaluative studies, as well as a study to assess the impact of the returnees from South Africa on [the] employment market. [The] Bureau of Statistics of this Ministry will undertake [a] decennial census. It may undertake some demographic studies on fertility, mortality, and migration as per [the] recommendation of the Interministerial Technical Committee (IMTC) on Population established in the Economic Policy Department.

Role of Non-Government Organizations (NGOs)

Non-Government Organizations can play a vital role in arousing people's interest in family planning and educating them against taboos that thwart the process of accepting [the] small family norm. Lesotho Planned Parenthood Association (LPPA) and other NGOs should be encouraged to undertake family planning and MCH related projects with necessary financial assistance from the Government. The Ministry of Planning will develop appropriate subvention mechanisms of providing some grant to the NGOs.

Co-ordination and Institutional Mechanisms

In order to create a strong sense of responsibility both at [the] societal and [the] individual level towards population planning, various Ministries are going to be involved in population activities for which co-ordination at appropriate tiers of public administration is a sine qua non. Such mechanisms will ensure periodic review and monitoring of [the] progress of implementation of various projects and programmes and help enlist support at various functional levels in favor of [the] small family norm. Keeping this purpose in view, the following three coordination committees will be formed.

a) National Population Council (NPC): The head of the Government shall be the chairman of the Council. Honourable Ministers of Planning, Finance, Education, Health, Information, Agriculture and Home Affairs, Labour and Employment will be its members. A representative of the National Council of Non-Government Organization will also be a member of NPC. Department of Economic Policy, Population and Manpower Development will the Secretariat of this Council. The activities of the Council include formulation and review of Population Policy, monitoring progress and [m]aking major policy decisions as may be necessary to promote population activities and accelerate progress.

b) District Population Programme Coordination Committee: It will be headed by the District Secretary and consist of district level functionaries of the Ministries which have population projects and programmes in the district. The committee will take measures to accelerate population-related IEC activities; review progress of implementation of projects; and adopt appropriate measures to provide quality services to the people. Relevant Ministries will provide necessary resources to the committee to facilitate its tasks. Various field workers' efforts will be coordinated at this level.

c) Local Level Committee will be headed by a local chief with broad representation from local people and Governmental agencies to promote population family planning and MCH activities.

There will be an in-built mechanism for flow of information from the village level coordination committee to the National Population Council. The Village Level Coordination Committee will be accountable to the District Level Coordination Committee which, in turn, will be accountable to the National Population Council for its activities. The Ministry of Planning will work out the details as to the ways each of these institutions will function in [an] operational sense.

d) Interministerial Technical Committee (IMTC):

[The] Interministerial Technical Committee established in [the] Ministry of Planning to advise on matters relating to population issues, research, annual publication of population data, etc., will continue to function. It will also service as an advisory body to the National Population Council on population-related matters, as and when needed.

Financial Outlay

Population activities during this plan period would include (i) Family Planning and MCH Service delivery; (ii) Women's programmes combined with population and MCH education; (iii) Information, Education and Communication (IEC); (iv) Research, Evaluation and Monitoring; (v) Training and Manpower Development; and (vi) other related activities. In order to carry out these activities, an amount of US $ 10.0 million will be necessary, in which ratio of donors and government contribution would be 8:2. According to priority, allocation to various activities is as follows:

(in US $)

(a) Service Delivery 4.5 million

(b) Women's Programmes 1.5 million

(IEC).

(d) Research, Evaluation and Monitoring,

Policy Planning and Census 1.5 million

(e) Training and Manpower Development 0.8 million

(f) Other activities including support

to the Secretariat of the NPC and

other local bodies. 0.2 million

(g) Support to Non-Government

Organizations (NGO) 0.8 million

The above allocation is indicative and subject to availability of funds as well as intra sectoral adjustment.