Nurse Mahali Lethetsa, left, and Mabatloung Mofolo, nurse-in-charge, check a patient's records in the MDR-TB ward at Botsabelo Hospital in Maseru, Lesotho.
Photo by Cecille Joan Avila / Partners In Health

In the small, landlocked nation of Lesotho, in southern Africa, the challenges to providing high-quality health care can be as tall as the mountains. 

Many of Lesotho’s 2.2 million people live in remote villages that are hours away from the nearest health facility. They take long treks or costly taxi rides to access care, often traveling over steep slopes, across rough terrain and through harsh weather, even snow, in the only country in the world with an elevation entirely above 1,000 meters. 


Nonetheless, a sweeping health reform is bringing transformative change across Lesotho. Partners In Health, known locally as Bo-mphato Litsebeletsong Tsa Bophelo, is working with the government to strengthen the country's health system, combat some of the world’s highest rates of HIV and tuberculosis, vastly improve maternal and child health, and reshape how care is delivered. 


We've worked in Lesotho since 2006, when the government invited us to support its response to the HIV epidemic. Since then, Lesotho’s Ministry of Health and PIH launched a comprehensive, integrated primary health care program to bring HIV care to more than 90,000 people served by seven mountain clinics, in the most remote areas of the country. The program has since enrolled thousands of people in long-term HIV treatment. 


PIH also is helping the Ministry of Health fight TB. In response to Lesotho's high prevalence of multidrug-resistant TB, PIH launched the country's first treatment, care and support program for MDR-TB, and the even more severe XDR (extensively drug-resistant) TB, in 2007. The program is based at the PIH-supported Botšabelo Hospital, in the capital city of Maseru. Botšabelo primarily serves critical patients who need intensive monitoring and care. The program also is community-based, with significant outreach across the country and localized care for more stable TB patients.


The multi-year success of the HIV and TB programs helped build a foundation for a comprehensive reform of Lesotho's health system. That reform began in 2014, with PIH as the government’s primary technical advisor. The reform supports more than 70 health centers across four districts, and reaches about 40 percent of Lesotho’s population. Work is underway to scale the reform nationally. The main goal is improvement of primary health care services, with a special focus on maternal and child health. The reform also is fueling improvements such as maternal waiting homes at every health center, to give expectant mothers a safe place to stay before birth, ensure they are near care when labor begins, and provide emergency referrals to hospitals if complications arise. Newborns are then given free checkups, immunizations and care through childhood, to make sure families start healthy and stay healthy. 


The foundation of PIH’s work in Lesotho is a vast network of community health workers, who visit families and neighbors in their homes to provide support and access to care. They are vital to PIH’s goal, which is nothing short of making that access universal in this beautiful country known as the Mountain Kingdom.