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Lesotho is a small mountainous kingdom entirely surrounded by the Republic of South Africa. Nearly three-quarters of the country’s 1.9 million people live in rural areas and an estimated 56.6 percent of the population lives below the poverty line. Lesotho’s economy is heavily dependent on the South Africa and is largely based on textile manufacturing the export of water.
Health Care System
Lesotho’s health system operates at three levels: the national (tertiary), the district (secondary), and the community (primary). Since 2004, the Government of Lesotho has sought to decentralize government services to the district level. However, accessing health services continues to be exceedingly difficult for many Basotho due to the country’s mountainous terrain, poor road system, high transportation costs, and chronic personnel shortages.
At 23.3 percent, adult HIV seroprevalence in Lesotho is critically high. In 2009, an estimated 48 percent of those in need of antiretroviral treatment received it and 64 percent of pregnant women living with HIV received antiretrovirals to prevent mother-to-child transmission of HIV. While HIV has reversed most economic and social development gains made over the past decades, there has been some meaningful progress in addressing the HIV epidemic in Lesotho. Over 83,000 people have now been enrolled on antiretroviral therapy and, according to the 2012 UNAIDS Global Report, new HIV infections in Lesotho have decreased by 16 percent in recent years.
ICAP in Lesotho
In Lesotho, ICAP implements programs aimed at strengthening capacity, policies, and systems in order to improve health service delivery throughout the country. ICAP has worked in close partnership with the Ministry of Health to develop a sustainable program that emphasizes in-country ownership.
As Lesotho has a high rate of TB/HIV co-infection, one of ICAP’s current focus areas in the country is TB/HIV integration. ICAP provides technical assistance at the national, district, and community level, with key innovations including:
- Enhancing the package care to increase antiretroviral therapy uptake among TB infected patients
- Utilizing the village health worker system to develop a sustainable mechanism of tracing people who may have been exposed to TB
- Using cell phone technology to improve adherence to medication
- Guiding the development of an operational plan to implement GeneXpert (which is used for TB diagnosis and the rapid identification of resistance to TB medications)
A key characteristic of the health system in Lesotho is that it is nurse-based. Through the Nurse Education Partnership Initiative (NEPI), ICAP supports the country’s six nursing training institutions to increase the number of practicing nurses in the country and to ensure that these nurses are highly skilled. Key accomplishments include:
- Introducing e-learning as a method of teaching in nursing schools
- Redesigning the curriculum to enable “outcomes-based” teaching
- Establishing a system to enhance the clinical competencies of training nurses
- Establishing quality assurance systems that are in line with the Ministry of Education and Training’s policies
- Facilitating mechanisms for multi-sectoral collaboration of relevant ministries in Lesotho to promote the sustainability of nursing education interventions
ICAP is also conducting essential research in Lesotho, with the goal of developing an Enhanced Prevention Package for Discordant Couples. The package of interventions consists of a combination of behavioral and biomedical prevention interventions that are informed by the determinants of risk behavior within discordant couples.