Health System Strengthening Using Problem Solving for Better Health in Lesotho

Abstract Background Problem Solving for Better Health ® (PSBH ® ) is a system-strengthening workshop designed to empower healthcare workers (HCWs) to solve problems. We report on the perspectives of HCWs trained in PSBH to better understand the impact and challenges of PSBH in Lesotho, a country with among the highest prevalence of HIV and tuberculosis in the world. Methods HCWs who attended PSBH workshops in 2018 – 2019 were interviewed using a semi-structured interview guide developed from a hybrid conceptual framework that captured the HCWs’ personal, interpersonal, and systemic levels of experience. Interviews were transcribed and analyzed using the framework matrix analysis method using NVivo. Results We interviewed 22 of the 86 HCWs who participated in PSBH workshops in 2018-2019. Twenty out of 22 interview participants reported that they initiated a project that was planned during the PSBH workshop. Participants reported that PSBH provided them with a new way of viewing, addressing, and solving everyday problems that can have a tangible impact on the function of healthcare facilities and the health of the community. Trainees were motivated to see the impact of their work in their jobs and in the work of subordinates as a sustained ripple effect favoring quality improvement. Participants suggested that training of district administrative leaders in PSBH would facilitate successful dissemination and help overcome the challenge of adding more work for the already-overburdened HCWs. Conclusions HCWs in Lesotho report that PSBH assists them in solving problems in their everyday work. This led the national Ministry of Health Quality Assurance Unit to request that PSBH workshops be conducted to train Ministry personnel to allow them to oversee national dissemination of PSBH, thereby fulfilling a component of the National Quality Assurance Strategic Objectives.