PIH Lesotho / Bo-Mphato Litšebeletsong tsa Bophelo

The situation in Lesotho

A small, mountainous nation of 1.8 million people located entirely within the borders of South Africa, Lesotho suffers from the third highest rate of HIV infection in the world. Almost one quarter of the adult population are estimated to be HIV-positive, of whom less than one quarter is aware of the infection.

A child in the rural mountains of Lesotho.

Lesotho also suffers from one of the highest rates of tuberculosis infection in the world (634 new cases per 100,000 per year, compared to just 4 per 100,000 in the U.S.). The majority of people infected with TB in Lesotho are also HIV-positive and nearly 1,000 people each year contract strains of TB that are resistant to all first-line drugs.

The HIV and TB epidemics in Lesotho are driven by poverty and high rates of migration for labor in South Africa. Lesotho has only one doctor for every 20,000 people, compared to one for every 390 people in the U.S. Only 7 percent of households have access to electricity and only 12 percent to running water. As the HIV/AIDS epidemic has taken hold, average life expectancy has plummeted below 40 years. Outside of the capital city of Maseru, most of the population lives in remote mountain villages, several hours walk from the nearest medical outpost.

PIH’s work in Lesotho

PIH Lesotho was launched in 2006 following an invitation from the government of Lesotho and consultation with the Clinton Health Access Initiative (CHAI). The project began with a focus on using HIV and TB prevention and treatment programs as an entry point to build capacity to address the major health problems faced by the country's poor, rural communities. 

PIH Lesotho brings health care to remote villages high in the mountains, which are often accessible only by single-engine propeller aircraft or by rough dirt roads carved into the mountains. A central office in the capital of Maseru coordinates logistics, procurement and communications for a network of eight remote rural health centers:

• Mamohau
• Nohana
• Bobete
• Nkau
• Lebakeng
• Tlhanyaku
• Methalaneng
• Manamaneng 

These facilities serve a combined population of more than 235,000 people. Transport of people and supplies is supported through partnerships with the Lesotho Flying Doctors Service (supported by the Ministry of Health and Social Welfare) and Mission Aviation Fellowship.

The eight health centers provide clinical support, training for nurses and village health workers, and supervise community-based treatment for HIV/AIDS and TB. Other services offered at the health centers include prevention of mother-to-child transmission of HIV (PMTCT), vaccinations, and family planning.

With the World Food Program, PIH is also providing nutritional support for HIV and TB patients, pregnant women, malnourished children and others who show clinical signs of malnutrition.

	An MDR-TB patient being treated at Botsabelo Hospital.
	Maternal Health Workers at a training session.

In 2007, PIH launched the country’s first-ever treatment program for multidrug-resistant tuberculosis (MDR-TB) to address the extremely high rates of HIV/TB co-infection. Since then, hundreds of patients have entered this program. With funding from Open Society Institute (OSI) and in partnership with Lesotho’s Ministry of Health, PIH refurbished the national TB laboratory and opened Botsabelo Hospital, a new MDR-TB hospital in the capital city of Maseru. This new facility treats critically ill MDR-TB patients and serves as PIH’s center for training doctors and nurses from throughout Africa in the management of MDR-TB/HIV coinfection.

With support from the Elton John AIDS Foundation, PIH began a pilot project to strengthen services for pregnant women. The health center, in consultation with the villages, trained 100 Maternal Health Workers (MHWs). These specialized community health workers identify and counsel women in their communities about the importance of prenatal care, accompany them to checkups, and bring them the health center to deliver their babies. In 2011, nearly 2,000 pregnant women in rural Lesotho received prenatal care through PIH. Read more.

See a timeline of PIH’s work in Lesotho.

Learn more about PIH Lesotho initiatives.