PIH Lesotho project history

2006 – At the beginning of the year, PIH is invited by the government of Lesotho and the Clinton HIV/AIDS Initiative to launch a project to bring HIV treatment and quality primary care to mountainous, rural areas. A team is assembled headed by Dr. Jennifer Furin (country director) and Dr. Salmaan Keshavjee (deputy country director) and a Lesotho partner organization is formed – Bo-Mphato Litšebeletsong tsa Bophelo, also known as PIHL. In June and July, PIHL begins training Village Health Workers and treating patients at Nohana, the first of 7 mountain clinics, working with the Lesotho Flying Doctors Service and Mission Aviation Fellowship. By the end of the year, nearly 200 patients are receiving antiretroviral therapy (ART) at the Nohana Health Center and more than 450 are enrolled in pre-ART care.

2007 – The Rural Initiative expands to three more mountain health centers – Bobete, Nkau and Lebakeng. By December, over 8,600 patients have been tested for HIV since the program began. 30 percent of those tested, over 2,700 patients, are HIV positive, and PIHL is treating more than 1,200 of them with lifesaving ART. In addition, more than 500 cases of TB have been diagnosed and treated in the rural clinics - more than 82% are co-infected with HIV. With funding from Open Society Institute (OSI) and in partnership with the Ministry of Health, PIH launches Lesotho’s first-ever treatment program for multidrug-resistant tuberculosis (MDR-TB). The PIHL team renovates the national TB laboratory, Maseru TB Clinic, and turns an old leprosy hospital into a state- of-the-art MDR-TB hospital, complete with a negative air pressure system to aid in infection control. By late December, 43 patients have been diagnosed and have started the arduous two-year treatment for MDR-TB.

2008 – The Rural Initiative expands to Tlhanyaku and Methalaneng, bringing comprehensive health care at a total of six facilities serving a population of more than 175,000 people. Confronted by an alarming increase in the number of malnourished children, with help from the government of Ireland, PIHL launches a supplementary feeding program to provide nutritional support to all malnourished children in the areas served by the Rural Initiative mountain health centers. The MDR-TB program is now treating patients in all 10 districts of Lesotho. To date, not a single patient has defaulted from the arduous two-year course of treatment.

2009 – The Rural Initiative begins working in a seventh remote mountain clinic in Manamaneng. In total, the 7 clinics log 143,600 patient visits and test almost 13,000 individuals for HIV. A pilot project to increase access for pregnant women to HIV testing, prenatal care and clinic delivery is launched at Bobete health center with support from the Elton John AIDS Foundation. Partnering with the Ministry of Health, PIH Lesotho trains healthcare staff throughout the country on treating MDR-TB and MDR-TB/HIV co-infection. All patients with suspected MDR-TB in Lesotho are referred for treatment and the program has become a beacon for other sub-Saharan countries looking to implement MDR-TB treatment; to date, the program has provided training for medical professionals from Ethiopia, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe and Malawi.

2010 – Major initiatives include scaling up the maternal health initiative to other rural health centers, increasing mobile outreach in the mountains to improve access to vaccinations and family planning, and increasing the number of MDR-TB patients receiving community-based treatment. Training doctors from other countries in the treatment of MDR-TB continues, with PIH Lesotho welcoming teams from Zambia, Ethiopia and Zimbabwe to Maseru.

2011 – In March, PIH-L expanded its network of supported health facilities in the rural mountain districts to include Mamohau Hospital. When PIH removed user fees at the hospital in April, the number of patient visits more than tripled. The scale up of a successful pilot program to improve women's access to prenatal and delivery care helped thousands of new mothers. PIH-Lesotho's Maternal Mortality Reduction Program hired and trained more than 450 CHWs to educate women about the importance of facility-based care. PIH-L also continued to support more than 75 orphans and vulnerable children. During the program's 6th year, PIH-Lesotho logged 77,000 patient visits and offers health services to a catchment area of roughly 235,000 people.