PIH Lesotho / Bo-Mphato Lit�ebeletsong 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.

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.

Learn more about the situation in Lesotho.

PIH’s work in Lesotho

PIH Lesotho was launched in 2006 following an invitation from the government of Lesotho and consultation with our partners in Rwanda, the Clinton HIV/AIDS Initiative (CHAI, now known as the Clinton Health Access Initiative). As in Rwanda, PIH began with a focus on bringing HIV and TB care and treatment to poor, rural communities.

In Lesotho, remote villages high in the mountains are often accessible only by single-engine propeller aircraft or by rough dirt roads carved into the mountains. To reach the Lebakeng health center by land, people and supplies must be transported across the river and then complete the journey by donkey or horseback.

PIH Lesotho provides clinical support, training for nurses and village health workers and supervised 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.

A central office in the capital of Maseru coordinates logistics, procurement and communications for a network of 8 remote rural health centers: Mamohau, Nohana, Bobete, Nkau, Lebakeng, Tlhanyaku, Methalaneng and Manamaneng, which 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.

See a timeline of PIH’s work in Lesotho.

Drug-resistant tuberculosis

With funding from Open Society Institute (OSI) and in partnership with Lesotho’s Ministry of Health, in 2007 PIH launched the country’s first-ever treatment program for MDR-TB, recognizing the extremely high rates of HIV/TB co-infection.

In 2007, PIH refurbished the national TB laboratory and opening a new MDR-TB hospital in the capital city, Maseru. Previously a leprosy hospital, Botsabelo Hospital was converted into a 20-bed facility for the treatment of critically ill MDR-TB and MDR-TB/HIV co-infected patients, so that they can receive round-the-clock care. Renovations were extensive, including the installation of appropriate ventilation and infection control mechanisms, family/visiting areas, and other improvements to make the hospital a pleasant and humane environment for patients undergoing long-term treatment.

This facility also serves as PIH’s center for training doctors and nurses from throughout Africa in the management of MDR-TB/HIV coinfection. The first patients were admitted to the hospital at the end of September 2007 and since then the facility has been consistently filled to capacity.

As of the start of 2011, more than 500 patients have entered the treatment program for MDR-TB. Read more.

Maternal Health Initiative

In 2009, with support from the Elton John AIDS Foundation, PIH began a pilot project at the Bobete health center to increase services to pregnant women. The health center, in consultation with the villages, selected 100 Maternal Health Workers (MHWs) to be trained as specialized community health workers.

TBAs identify and counsel women in their villages about the importance of antenatal care (ANC) and delivery at the health center. MHWs receive incentives to accompany pregnant women to the health center for comprehensive ANC, which includes testing and treatment for HIV, STIs and anemia, and to accompany women for delivery at the health center. Because women generally live a long walk from the clinic, waiting houses near the health center provide temporary shelter in the week leading up to delivery.

In 2011, nearly 2,000 pregnant women in rural Lesotho received prenatal care through PIH. Read more.

Learn more about PIH Lesotho initiatives.
Contact PIH Lesotho: lesotho@pih.org