Lesotho suffers from the third-highest rate of HIV infection in the world—almost one-quarter of the adult population is estimated to be HIV-positive. By some estimates, average life expectancy is less than 40 years. Lesotho’s steep mountains and harsh weather also restrict access to health services for many people. Many patients must walk an average of three to five hours over steep terrain to reach medical facilities.

PIH/Lesotho (PIH/L), launched in 2006 at the invitation of Lesotho’s government and in consultation with the Clinton Health Access Initiative, works to improve the health of eight remote mountain communities, providing integrated services for maternal and child health, HIV, and tuberculosis, while managing the national program to treat multidrug-resistant tuberculosis (MDR-TB). The program brings health care to nearly 200,000 people.

PIH/L has made strengthening services for women and children under age 5 a top priority. More than 600 village women have been trained and employed to visit pregnant women regularly and accompany them to health centers for pre- and postnatal visits and to deliver their babies. The network of remote rural health facilities offers comprehensive services for all patients, including HIV, tuberculosis, and malnutrition programs.

Lesotho’s national health care reform

PIH/L has been collaborating with the Ministry of Health to improve care across Lesotho as part of a five-year, three-phase reform. PIH/L has provided technical supervision, follow up, and training of clinical staff. Efforts have included training and recruiting village health workers, food assistance for mothers, maternal waiting homes, and support for emergency referral for transportation.

The Lesotho Ministry of Health and PIH/L started working on a plan for national reform in 2013. A central goal of the reform is that all health clinics will be able to deliver a comparable level of care to what PIH/L has been delivering for years. Although PIH/L will continue to be involved in training staff and providing technical assistance, the health centers will remain under the purview of the Ministry of Health.

A focus on tuberculosis

In 2007, PIH/L—in partnership with the Ministry of Health—launched the country’s first treatment program for MDR-TB to address a growing epidemic and extremely high rates of HIV/TB co-infection. Since then, more than 800 patients have entered this program, which is based at Botsabelo Hospital in Maseru, a facility for critically ill MDR-TB patients.

The facility also serves as a training center for clinicians from throughout Africa who come to learn about the management of MDR-TB and TB/HIV co-infection. In 2012, PIH/L completed construction of the new government-run national TB reference laboratory that will serve all of Lesotho