Lesotho is a small mountainous kingdom surrounded entirely by the Republic of South Africa. Nearly three-quarters of the country’s 1.8 million people live in rural areas. Lesotho’s economy is heavily dependent on the South African economy and is largely based on exports of water and textile manufacturing. Per capita income is estimated at $552 US.

Health Care System
Lesotho’s health care services are delivered primarily by the Government of Lesotho and the Christian Health Association of Lesotho. The country’s health care system suffers from chronic personnel shortages, particularly in remote and rural areas. There are 3,790 health care workers, including 1,123 nurses, formally employed by the health sector.
Access to health services is difficult for many people, especially in rural areas, because of the country’s mountainous terrain, poor road system, and high transportation costs. To increase access to health services, especially for the country’s rural population, the Lesotho government initiated a program in 2000 to decentralize the healthcare system. This effort, however, has been stymied by limited funding and human resource shortages.

HIV/AIDS in Lesotho
With 23.2 percent of the population infected with HIV, Lesotho, along with Swaziland and Botswana, is among the top three countries in the world most severely affected by HIV/AIDS. HIV seroprevalence is higher in urban areas than in rural areas, with an average prevalence of 31.1 and 22.2 percent, respectively. An estimated 270,000 people in Lesotho are living with HIV/AIDS. Currently, only 25 percent of those who need antiretroviral treatment (ART) are receiving it. Similarly, services for the prevention of mother-to-child transmission (PMTCT) of HIV are only reaching 38 percent of pregnant women. HIV/AIDS has dramatically reversed most economic and social development gains made over the past decades in Lesotho. As a result of HIV/AIDS, life expectancy fell from 60 years of age in 1996 to 35 in 2003. In 2006, the government launched a five-year National AIDS Policy and Strategic Plan to combat HIV/AIDS. A “Know Your Status” campaign was also initiated with the goal of getting every person in Lesotho to take an HIV test and learn their status.

ICAP in Lesotho
Since 2006, ICAP has been supporting PMTCT services and comprehensive HIV/AIDS care and treatment programs in Lesotho for HIV-infected pregnant women, their partners, and families. The development of an integrated family-centered approach to HIV care and treatment in Lesotho was motivated by several critical areas identified by the Lesotho Ministry of Health and Social Welfare (MOHSW). They include the needs to integrate a package of PMTCT services into routine antenatal and postnatal consultations; establish supportive services for HIV pregnant women and their families; and provide HIV care and treatment to all HIV-infected pregnant women, HIV-exposed infants, infected children, partners and family members.
In support of the MOHSW goals, ICAP provides technical and clinical assistance to health facilities in the development and enhancement of family-centered, multidisciplinary HIV/AIDS prevention, care, and treatment programs, with the goal of reducing HIV/AIDS-related morbidity and mortality among children, women, and their family members. ICAP also supports training activities in Maseru, Mohale’s Hoek, Mafeteng and Quthing districts to build capacity of healthcare workers for delivering high-quality, comprehensive HIV/AIDS services and enhancing monitoring and evaluation systems. In addition to providing clinical mentoring and supervision, ICAP supports workshops and multidisciplinary team meetings for providers focused on skills-building, performance improvement, and continuing education on comprehensive HIV/AIDS service delivery.

ICAP clinical officers provide at least two days a week of supportive supervision at the site level. In addition, ICAP works with facilities to maximize human resource capacity by shifting tasks among health care providers and reducing staff rotations among departments. ICAP also supports the hiring of site coordinators, data officers and adherence and psychosocial support officers to support multidisciplinary teams of providers at both the district and site levels.

Working in collaboration with the MOHSW, ICAP provides technical support for national trainings and workshops on the Integrated Management of Adult Illness (IMAI) approach to healthcare. Mirroring ICAP’s multidisciplinary, comprehensive approach to HIV/AIDS services, IMAI is being implemented as part of the national decentralization of health care services. By building site level capacity and engaging organizations of people living with HIV/AIDS, IMAI allows for expanded delivery of HIV prevention, care, and treatment services.

Support for Programmatic Activities
In Lesotho, ICAP supports a range of capacity-building activities including:

  • Working with the Ministry and Health Social Welfare in the development of national plans and strategies for enhancing PMTCT and MTCT-Plus programming. This includes support for program planning and monitoring and evaluation activities;
  • Enhancing multidisciplinary teams at the site level through on-site workshops, supportive supervision, retreats focusing on the MTCT-Plus model of care, as well as clinical mentoring and preceptorship;
  • Increasing follow-up of HIV-exposed infants and uptake of cotrimoxazole prophylaxis for the prevention of pneumocystis jiroveci;
  • Promoting best infant feeding practices among HIV-positive women;
  • Integrating provider-initiated HIV testing throughout the continuum of maternal-child health services;
  • Enhancing ART services for HIV-infected children;
  • Building linkages with communities and empowering them to mitigate the effect of HIV on families.

Key Collaborating Partners

  • Elizabeth Glaser Pediatric AIDS Foundation
  • Clinton Foundation HIV/AIDS Initiative
  • Baylor International Pediatric AIDS Initiative
  • United Nations -– United Nations Children’s Fund, United National Population Fund, World Health Organization
  • Population Services International
  • German Agency for Technical Collaboration

Map of ICAP-supported Sites in Lesotho