**3. Healthcare human resources**

Health worker density is the most widely used indicator to determine available human resources [23]. The WHO has set a density indicator of 2.23 healthcare professionals per 1000 population as the minimum threshold for access to public healthcare services [24]. Within that benchmark, significant variance exists between regions regarding the particular skills-mix of doctors, nurses and midwives. In the Africa continent, there are on average five nurses/midwives per doctor [25]. Zimbabwe's health worker density at 1.45 per 1000 of the population is higher than those of Sierra Leone and South Sudan but is still less than the WHO's density benchmark [23]. In Botswana, according to Nkomazana et al., the health worker density is 3.4 doctors and 28.4 nurses per 10,000 of the population [25]. In Lesotho, however, health workforce is challenged to meet the needs of its population. The nursing and midwifery workforce is 6.0 per 10,000 compared with neighbouring South Africa's 41 per 10,000 and 11 per 10,000 for the Africa region [24].

The Lesotho government staff establishment has not been reviewed; therefore it does not take care of health cadres that are needed resulting from the use of modern health technologies, for example, equipment, devices and protocols [26]. Furthermore, there is an acute shortage of expertise within the health sector with many posts on the establishment list of the MoH remaining unfilled. The overall establishment list of the MoH was at the beginning of the year 2015 was 4610. Over half (54%) of nurse and midwife posts remain vacant in rural areas [27]. At the end of the 2015 financial year, only 23% of all vacancies were filled. Several factors have been associated with this, such as local circumstances that negatively impacted on training, pay, infrastructure and working conditions [26]. However, the country could consider changing some of the posts to cover other cadres in order to add diversity to the nursing cadres and leave nursing within the mandatory scope of work that is done well.
