WHO COUNTRY COOPERATION STRATEGY - 2014-2019 LESOTHO - COOPERATION STRATEGY 2014 2019 - World Health ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
WHO COUNTRY
COOPERATION
STRATEGY
2014-2019
LESOTHO
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 i
COOPERATION STRATEGY - Lesotho 2 - Final.indd 1 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
AFRO Library Cataloguing-in-Publication Data
WHO Country Cooperation Strategy 2014-2019 Lesotho
1. Health planning
2. Health plan Implementation
3. Health Priorities
4. International cooperation
I. World Health Organization. Regional Office for Africa
ISBN: 978 92 9 023207 0 (NLM Classification: WA 540 HE8)
© WHO Regional Office for Africa, 2014
Publications of the World Health Organization enjoy copyright protection in
accordance with the provisions of Protocol 2 of the Universal Copyright Convention.
All rights reserved. Copies of this publication may be obtained from the Library, WHO
Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241
39100; Fax: +47 241 39507; E-mail: afrobooks@who.int). Requests for permission
to reproduce or translate this publication, whether for sale or for non-commercial
distribution, should be sent to the same address.
The designations employed and the presentation of the material in this publication do
not imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of
its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
lines on maps represent approximate border lines for which there may not yet be full
agreement.
The mention of specific companies or of certain manufacturers’ products does not
imply that they are endorsed or recommended by the World Health Organization in
preference to others of a similar nature that are not mentioned. Errors and omissions
excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to
verify the information contained in this publication. However, the published material
is being distributed without warranty of any kind, either express or implied. The
responsibility for the interpretation and use of the material lies with the reader. In no
event shall the World Health Organization or its Regional Office for Africa be liable for
damages arising from its use.
The conceptual designs were done in AFRO and laid out and Printed in Lesotho
ii
COOPERATION STRATEGY - Lesotho 2 - Final.indd 2 2015/07/09 1:46 AMContents:
CONTENTS
ACRONYMS………………………………………………………………………...v
PREFACE…………………………………………………………………………..ix
ACKNOWLEDGEMENTS…………………………………………………..…….xi
EXECUTIVE SUMMARY…………………………………………………………xiii
SECTION 1: INTRODUCTION ………………………………………..……..…1
SECTION 2: COUNTRY HEALTH AND DEVELOPMENT
CHALLENGES .........................................................................3
2.1 Geography ………….......................................................…………….............3
2.2 Demographic Profile and Characteristics of Population ……………................3
2.3 Politics and Governance Structure ……...…………………………….........…....4
2.4 Socioeconomic Status ………..........................................................................5
2.5 Social Determinants of Health ..……………………….........................…..........6
2.6 Health Status of the Population .………………………..………..............…......8
2.7 National Response to Overcoming Health Challenges …………….....….…...11
2.8 Health Systems and Services ………...................................................…......15
SECTION 3: DEVELOPMENT COOPERATION AND PARTNERSHIPS ....17
3.1 Aid Environment in the Country ………........………………………................. 17
3.2 Coordination and Aid Effectiveness int he Country ……………….…............ 18
3.3 UN Reforms Status and UNDAF Process ……..............………….........…… 19
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 iii
COOPERATION STRATEGY - Lesotho 2 - Final.indd 3 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
SECTION 4: REVIEW OF WHO COOPERATION OVER CCS2G .............. 21
4.1 Support from Headquarters and AFRO .......……..……………....................... 22
4.2 WHO responses to changing country needs ........……………....................... 22
4.3 Other Partners .......……..……………............................................................. 23
4.4 Achievements of CCS2G .......……..……......................………....................... 24
4.5 Challenges in Implementation of CCS2G …..…..............………….........…… 27
SECTION 5: STRATEGIC AGENDA FOR WHO COOPERATION.............. 31
5.1 Validation of CCS strategic agenda with National Policy ……....................... 41
5.2 Validating CCS strategic agends with UNDAF/LUMDAF ........……............... 41
5.3 Validating CCS strategic agenda with WHO Global and Regional Priorities . 41
SECTION 6: IMPLEMENTING STRATEGIC AGENDA:
IMPLICATIONS FOR WHO..................................................... 43
6.1 Nature and Level of Support Needed from WHO Regional
Office and Headquarters .......……..……………............................................. 43
6.2 Appropriate competences and skills required to implement CCS3G ........…. 44
SECTION 7: MONITORING AND EVALUATION ........................................ 47
REFERENCES ........................................................................................... 49
ANNEX:
Annex A: CCS Development Process .....................................……....................... 55
Annex B: Health Development Support 2010/11 to 2012/13 ................................. 55
Annex C: SWOT Analysis .......................................................……........................ 56
Annex D: Comparison of CCS3G and Health Sector Priorities ..…........................ 57
Annex E: LUNDAP Outcomes Compared to CCS3G Priorities ............................. 58
Annex F: Validating the CCS Strategic Agenda with WHO Global Priorities ......... 58
Annex G: Validating the CCS Strategic Agenda with WHO Regional Priorities ..... 59
iv
COOPERATION STRATEGY - Lesotho 2 - Final.indd 4 2015/07/09 1:46 AMACRONYMS:
ADAAL Anti-Drug and Alcohol Association of Lesotho
ADB African Development Bank
AFP Acute Flaccid Paralysis
AFRO Regional Office for Africa (WHO)
AGOA African Growth and Opportunities Act
AJR Annual Joint Review
ART Anti-Retroviral Treatment
BCC Behaviour Change Communication
BNP Basotho National Party
BUMC Boston University Management Consultants
CBL Central Bank of Lesotho
CCS Country Corporation Strategy
CCS2G CCS Second Generation
CCS3G CCS Third Generation
CD Communicable Diseases
CHAL Christian Health Association of Lesotho
CV Curriculum Vitae
DG Director-General of WHO
DHHS Director General of Health Services
DHMT District Health Management Team
DHPS Department of Health Planning and Statistics
DHS Demographic and Health Survey
DMA Disaster Management Authority
DQS Data Quality Self-Assessment
DVDMT District Vaccine Data Management Tool
EMR Electronic Medical Records
EPI Expanded Program on Immunization
EPDMS Electronic Performance Management Development System
EU European Union
FCTC Framework Convention on Tobacco Control
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 v
COOPERATION STRATEGY - Lesotho 2 - Final.indd 5 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
FIND Foundation for Innovative New Diagnostics
GAVI Global Alliance for Vaccines and Immunizations
GOL Government of Lesotho
GPW General Program of Work
HDI Human Development Index
HHA Harmonization for Health in Africa
HIV & AIDS Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
HMIS Health Management Information System
HPV Human Papilloma Virus
HQ Head Quarters of WHO
HRH Human Resources for Health
HSA Health Service Area
HSR Health Sector Reforms
HSS Health Systems Strengthening
HTAP HIV and AIDS Technical Assistance Program
HTC HIV Testing and Counselling
ICD10 International Coding of Diseases 10th Revision
ICT Information and Communication Technology
ICU Intensive Care Unit
IDSR Integrated Disease Surveillance and Response
IEC Information, Education and Communication
IHM International Health Measurement
IMR Infant Mortality Rate
IST Intercountry Support Team
KNCV Royal Netherlands TB Foundation
LBTS Lesotho Blood Transfusion Services
LDC Least Developed Countries
LPPA Lesotho Planned Parenthood Association
LRCS Lesotho Red Cross Society
LUNDAP Lesotho United Nations Development Assistance Plan
M&E Monitoring and Evaluation
MAF MDG Acceleration Framework
MCC Millennium Challenge Corporation
MDG Millennium Development Goals
vi
COOPERATION STRATEGY - Lesotho 2 - Final.indd 6 2015/07/09 1:46 AMMDR-TB Multi-Drug-Resistant TB
MMR Maternal Mortality Ratio
MOF Ministry of Finance
MOH Ministry of Health
MTSP Medium Term Strategic Plan
NAC National AIDS Commission
NCD Non-communicable Diseases
NGO Nongovernmental Organization
NHPSP National Health Policy, Strategies and Plans
NNICU Neonatal Intensive Care Unit
NORAD Norwegian Agency for Development Cooperation
NSDP National Strategic Development Plan
PAU Projects Accounting Unit
PBF Performance Based Financing
PEPFAR President’s Emergency Plan for AIDS Relief
PHC Primary Health Care
PIH Partners in Health
PITCT Provider Initiated Counselling and Testing
PMNCH Partnership on Maternal Newborn and Child Health
PMTCT Prevention of Mother to Child Transmission
PNC Post Natal Clinic
POA Plan of Action
PPP Public Private Partnerships
PRSP Poverty Reduction Strategy Paper
PSI Population Services International
PWD People Living with Disability
QMMH Queen ‘Mamohato Memorial Hospital
RB Regular Budget
RED Reaching Every District
SACU Southern Africa Customs Union
SADC Southern African Development Community
SHI Social Health Insurance
SIA Supplementary Immunization Activity
SWAP Sector-Wide Approach
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 - 2 0 1 9 vii
COOPERATION STRATEGY - Lesotho 2 - Final.indd 7 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
SWOT Strengths, Weaknesses, Opportunities and Threats
TA Technical Assistance
TB Tuberculosis
TSR Treatment Success Rate
TWR Total Fertility Rate
UN United Nations
UNDAF United Nations Development Assistance Framework
UNDRMT UN Nations Disaster Risk Management Team
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
US United States
USG United States Government
VF Voluntary Contribution Fund
WCO WHO Country Office
WFP World Food Programme
WHA World Health Assembly
WHO World Health Organization
WR WHO Representative
XDR-TB Extensively Drug Resistant TB
viii
COOPERATION STRATEGY - Lesotho 2 - Final.indd 8 2015/07/09 1:46 AMPREFACE:
The WHO Third Generation Country Cooperation Strategy (CCS) crystallizes
the major reform agenda adopted by the World Health Assembly with a view
to strengthen WHO capacity and make its deliverables more responsive to
country needs. It reflects the WHO Twelfth General Programme of Work
at country level, it aims at achieving greater relevance of WHO’s technical
cooperation with Member States and focuses on identification of priorities
and efficiency measures in the implementation of WHO Programme Budget.
It takes into consideration the role of different partners including non-state
actors in providing support to Governments and communities.
The Third Generation CCS draws on lessons from the implementation of the
first and second generation CCS, the country focus strategy (policies, plans,
strategies and priorities), and the United Nations Development Assistance
Framework (UNDAF). The CCSs are also in line with the global health
context and the move towards Universal Health Coverage, integrating the
principles of alignment, harmonization and effectiveness, as formulated in
the Rome (2003), Paris (2005), Accra (2008), and Busan (2011) declarations
on Aid Effectiveness. Also taken into account are the principles underlying
the “Harmonization for Health in Africa” (HHA) and the “International Health
Partnership Plus” (IHP+) initiatives, reflecting the policy of decentralization
and enhancing the decision-making capacity of Governments to improve the
quality of public health programmes and interventions.
The document has been developed in a consultative manner with key health
stakeholders in the country and highlights the expectations of the work of the
WHO secretariat. In line with the renewed country focus strategy, the CCS is
to be used to communicate WHO’s involvement in the country; formulate the
WHO country workplan; advocate, mobilise resources and coordinate with
partners; and shape the health dimension of the UNDAF and other health
partnership platforms in the country.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 ix
COOPERATION STRATEGY - Lesotho 2 - Final.indd 9 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
I commend the efficient and effective leadership role played by the
Government in the conduct of this important exercise of developing the CCS.
I also request the entire WHO staff, particularly WHO Country Representative
to double their efforts to ensure effective implementation of the programmatic
orientations of this document for improved health outcomes which contribute
to health and development in Africa.
Dr Matshidiso Moeti
WHO Regional Director for Africa
x
COOPERATION STRATEGY - Lesotho 2 - Final.indd 10 2015/07/09 1:46 AMACKNOWLEDGEMENTS:
This Country Cooperation Strategy document is the product of a collaborative
effort between the different levels of the WHO, the Ministry of Health and
partners. We would like to express our appreciation to all who played a
supportive role during the preparation of this document.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 xi
COOPERATION STRATEGY - Lesotho 2 - Final.indd 11 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
xii
COOPERATION STRATEGY - Lesotho 2 - Final.indd 12 2015/07/09 1:46 AMExecutive Summary:
The Country Cooperation Strategy (CCS) is the key guiding tool providing
strategic direction for WHO and intensifying its interventions in the country.
The first CCS in Lesotho was operational from 2004 to 2007, followed by
the second CCS 2008-2013. Development of the new CCS to cover 2014–
2019 comes at an opportune time when the National Health Plan has just
been concluded and the sector strategic plan is in its finalization stage. The
development process for this CCS involved documentation review, and
both internal and external consultations which, were mainly in the form of
structured qualitative interviews.
Lesotho is a small mountainous country which is completely landlocked by
the Republic of South Africa. The country’s population is estimated at 1.8
million with gender distribution of 51.3% females and 48.7 % males. Life
expectancy is estimated at 41.2 years, i.e. 39.7 years for males and 42.9
years for females; this signifies a decline of ten years, in relation to the 1996
census, due partly to the HIV/AIDS pandemic. The Lesotho Government
is a constitutional monarchy with the King’s functions predominantly being
ceremonial. The country practices democratic governance, with a prime
minister as head of government with full executive authority.
Lesotho is classified as a Least Developed Country (LDC) with an estimated
income per capita of $1,000 and an annual economic growth rate of 4.4%.
The economic development of Lesotho has historically relied on remittances
from Basotho employed in South Africa, where employment declined in recent
years. The textiles and clothing manufacturing sub-sector has over the years
absorbed the greater part of employees, but employment declined by 10.4%
in 2011 due to economic recession, which resulted in the closure of some
firms. The 2008 Labour Force Survey Report records a 25% unemployment
rate, although the majority (71%) of the employed are found in the informal
sector where the practice of in-kind payments is common. Livestock and
major crop production levels fell over the years, resulting in a situation where
the country produced only 30.0% of its food requirements.
The country boasts of a high literacy rate, with an estimated 85% of the
population aged 15 years and above considered as literate. Female literacy
(94.5%) in Lesotho remains higher than male literacy. The Demographic and
Health Survey (DHS) of 2009 indicated that 80% of the population has access
to improved sources of water, while 24% has improved sanitation facilities.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 - 2 0 1 9 xiii
COOPERATION STRATEGY - Lesotho 2 - Final.indd 13 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
HIV and AIDS remains the major health challenge with an estimated national
prevalence of 23%. The ART coverage is at a low level of 51%. Lesotho is
reported to be one of the fifteen countries with the highest per capita TB
cases. On the other hand, the Treatment Success Rate (TSR) of 74% falls
short of the target of 85%. Treatment of Multi-Drug Resistant Tuberculosis
(MDR-TB) is donor-dependent, and the situation is worsening, as shown by
monthly enrolment for treatment. The prevalence of tobacco use is put at
39.3% among the youth, while alcohol drinking is reported at 31%. Diabetes
prevalence is also reported at 4% and cancer accounts for 4% of deaths.
Trauma is the second main reason for male admissions in hospitals due to
HIV and AIDS.
The government and its partners are engaged in a number of initiatives
to promote healthy living and to create awareness. The newly introduced
guidelines on Option B+ are implemented for prevention of Mother-to-Child
Transmission. In line with the MOH broad plan on integrated service, ‘Family
Health Days’ are also implemented. The number of facilities providing PMTCT
has increased from 191 in 2010 to 203 in 2012 and PMTCT coverage is 52%.
A 70% HIV sero-prevalence rate has been reported in April 2013 among TB
patients. Access to PAP smear services has been availed in all hospitals and
Lesotho Planned Parenthood Association (LPPA) clinics for early detection
of cervical cancer. Human Papilloma Virus (HPV) vaccine for prevention of
cervical cancer was also introduced. While immunization is known to be one
of the most successful and cost-effective public health investments that can
save children’s lives, immunization coverage is, on the average 60%, which
is far less than the target of 80%.
Since the advent of decentralization, health service delivery has been
entrusted to ten administrative districts of the country. There are two major
health service providers, namely the Government of Lesotho (GOL) and the
Christian Health Association of Lesotho (CHAL). The MOH has been able to
allocate 14.8% of total government budget to the health sector; this is close
to the Abuja declaration target of 15%.
Lesotho enjoys financial support from a number of health development
partners towards both budget support and specific sector priorities. For
the year 2012/2013, donor support constituted 25% of MOH capital
budget. There is a Health Partners’ Forum which sets a platform for health
development partners to share their areas of support to minimize or eliminate
duplication of efforts. The Annual Joint Review (AJR) was introduced as a
common monitoring mechanism for the Health Sector Review (HSR) and
xiv
COOPERATION STRATEGY - Lesotho 2 - Final.indd 14 2015/07/09 1:46 AMwas inaugurated in 2003. The UN embarked on ‘Delivering as One’ as a
strategy that provides an opportunity, not only to improve efficiency of the UN
programme, but also to strive for greater impact of its efforts in supporting the
National Strategic Development Plan (NSDP).
Although there is limited knowledge of the CCS2G content within the
MOH, the CCS2G priorities were broad enough to align with the ministry’s
priorities. Some achievements have been noted regarding implementation
of the CCS2G, with the pinnacle being completion of the National Health
Policy (NHP) and drafting of the strategic plan. These achievements were
made thanks to support from both WHO Regional Office and Headquarters.
Financial and human resources within the MOH and the WHO Country Office
(WCO) are the main challenges facing implementation of the CCS.
Determination of the strategic direction for WHO is based on the country’s
key health challenges, priorities, WHO priorities at global and regional level,
Lesotho United Nations Development Assistance Plan (LUNDAP) outcomes
and feedback from the consultations which have provided an overview of the
perceived comparative advantages of WHO. Five strategic priorities identified
for 2014–2019 include: (i) Strengthening the prevention and control of TB,
HIV & AIDS and other communicable diseases; (ii) strengthening maternal
and child health services; (iii) prevention and control of non-communicable
diseases; (iv) health systems strengthening and; (v) addressing the
sociocultural and environmental determinants of health. These are entirely
aligned to the priorities of WHO at all levels, the NHPSP and the LUNDAP.
Implementation of these will benefit from continued support from WHO
Regional Office and the Headquarters.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 - 2 0 1 9 xv
COOPERATION STRATEGY - Lesotho 2 - Final.indd 15 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
xvi
COOPERATION STRATEGY - Lesotho 2 - Final.indd 16 2015/07/09 1:46 AMSECTION 1:
INTRODUCTION
The Country Cooperation Strategy (CCS) is the key guiding tool which
provides the strategic direction of WHO’s work in the country. It gives a high-
level indication of WHO country support towards country specific health
priorities in an attempt to assist the country to meet its own health agenda.
To achieve this, the CCS aligns itself to the National Health Policy, Strategies
and Plans (NHPSP). It creates an opportunity for the WHO country work to
be harmonized with that of other players in the sector such as United Nations
(UN) agencies and other health development partners.
The first CCS in Lesotho was operational from 2004 to 2007. This was
followed by the second generation CCS (CCS2G 2008–2013) which expired
at the end of December 2013. It is therefore essential that the third generation
(CCS3G 2014–2019) be developed. This comes at an opportune time when
the NHP has just been concluded and the sector strategic plan is in the
finalization stage. The CCS2G had five (5) strategic areas as follows:
• Strengthening the control of HIV/AIDS and TB;
• Strengthening family and community health, including sexual and
reproductive health;
• Enhancing capacity for the prevention and control of major
communicable and non-communicable diseases;
• Strengthening health system capacities and performance;
• Fostering health sector partnerships, advocacy and equity.
The development process1 of this CCS involved consultations and extensive
review of documents relating to global, regional and country-specific health
issues to facilitate alignment. Consultations were in the form of structured
qualitative interviews to enable open and detailed feedback. These began
with internal stakeholders who are mainly WCO staff to establish the office’s
view on the implementation of the CCS2G and for the team to share their
thoughts towards the strategic agenda of the next CCS. Further consultations
1
Annex A provides details.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 1
COOPERATION STRATEGY - Lesotho 2 - Final.indd 1 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
were undertaken with the Ministry of Health (MOH) staff, mainly counterparts
of WHO technical team. Some UN agencies, health development partners
and representation of church-based organizations were also consulted to
establish their opinion about WHO and its contribution to achieving the
country’s health objectives, and to get guidance on the areas of focus for the
next CCS, based on their thoughts around the comparative advantages of
WHO. The people consulted individually constituted the review team, whose
collective contribution will be obtained during the validation process of this
document.
Internal consultations had limitations as some technical staff members
were either fairly new in the organization or were unfamiliar with the CCS
formulation process, and therefore were not able to provide much opinion
about the CCS under review.
To implement the CCS, WHO agrees with MOH on two yearly plans and
budget, the Biennial Plan of Action (POA), with the aim of providing a clear
detailed analysis of the areas of implementation in the respective two years.
The first POA for implementation of the CCS2G in Lesotho covered 2008–
2009 followed by 2010–2011 and then 2012–2013. WCO Lesotho has, on
average, a budget of US$ 5.0 million every 2 years and this can be exceeded
based on local resource mobilization efforts.
The Policy of WHO is guided by its member states through the annual
World Health Assembly (WHA). The WHO Global Agenda priorities are then
articulated by the General Programme of Work (GPW) in recognition of the
global health status and challenges. The 2014–2019 Global Health Agenda
as articulated by the 12th GPW identified six (6) leadership priority areas
which countries are expected to draw their priorities from in developing their
CCSs.
Lesotho is a member of the 47 countries in the WHO African Region whose
ministers of health contextualize and adapt the WHA priorities to their region.
This document is composed of six sections. The first section has defined
the CCS development process and WHO Policy Framework. The second
section provides an overview of the status of health and development in the
country and the challenges thereof. Section three analyses the role played
by health development partners and coordination mechanisms. The fourth
section reviews WHO cooperation in Lesotho with specific focus on the life-
cycle of the CCS2G. The fifth section highlights the proposed agenda for
this CCS, followed by section six which captures the implications for WHO in
implementing the CCS.
2
COOPERATION STRATEGY - Lesotho 2 - Final.indd 2 2015/07/09 1:46 AMSECTION 2:
COUNTRY HEALTH AND
DEVELOPMENT CHALLENGES
2.1 Geography
The Kingdom of Lesotho (former Basutoland) is a small2 mountainous
country which is completely landlocked by the Republic of South Africa. It
is made up mostly of highlands which rise to nearly 3,500 meters in the
Drakensburg Mountains. About one quarter of the country has altitudes of
between 1,500 and 2,000 metres. The highland area is where many of the
villages are hard to reach. The country is divided into four (4) ecological
zones, namely Highlands (Mountains), Foothills, Lowlands and Senqu River
Valley. The mountainous topography of the country presents difficult terrain
and arable land is limited. The rural highlands are less developed and winters
are severe with heavy snowfalls that often cut off the population from access
to basic social services such as health.
2.2 Geographic profile and characteristics
of population
According to the 2006 Lesotho population census, the country has a
population of 1880 661, with gender distribution of 51.3% and 48.7% females
and males respectively. The total population of three (3)3 of the ten districts is
more than half of the country’s population. These are inclusive of the capital
city, Maseru, which is the most populous with 22.9% of the population. The
rural areas of the country continue to have the highest percentage4 of the
2
30,355km2 of area
3
Leribe, Berea and Maseru
4
76% of the population
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 3
COOPERATION STRATEGY - Lesotho 2 - Final.indd 3 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
population, although there has been a decline over the years. The annual
growth rate of the population was 0.1% during the inter-census period of
1996 to 2006, which marks a significant decline5 compared to previous inter-
census periods.
Age distribution, as estimated in 2012, is as follows: Age groups 0–14 years
constituted 33.5%, 15–64 years, 61.1% while 65 years and over made up only
5.4% (Lesotho Country Profile, KPMG Proprietary Services 2012 and CIA
World Factbook). Estimates of the census of 2006 put overall life expectancy
at 41.2 years for the population, while for males and females these were 39.7
years and 42.9 years respectively. This is a significant decline of about 10
years, compared to the 1996 census figures. This decline in life expectancy
is attributed to the high mortality rate resulting from HIV and AIDS. The Total
Fertility Rate (TFR) was also reported as one of the lowest in sub-Saharan
Africa at 3.3 children per woman.
An estimated 99.7% of the people of Lesotho identify as Basotho. The main
language is Sesotho and it is the first official and administrative language.
English is the second official and administrative language. Other languages
used by the minority of the population include Ndebele, Xhosa and Zulu.
2.3 Politics and governance structure
The Lesotho Government is a constitutional monarchy with the King’s
functions predominantly being ceremonial, with no executive or legislative
powers. The monarch is hereditary. The country is governed by a bicameral
parliament consisting of a senate and an elected national assembly. The
prime minister is the head of government with executive authority.
Lesotho is a democratic country that allows a multi-party political system
following its independence from the British in 1966. During the same period,
the country was also renamed the Kingdom of Lesotho from Basutoland.
The first party to rule the country was Basotho National Party (BNP) and
the country experienced a lot of political instability relating to elections over
the years, including military coups. The last violent demonstrations against
election results were those of the 1998 post-elections, which prompted a brief
but bloody intervention by the combined South Africa and Botswana military
forces under the auspices of the Southern African Development Community
(SADC). The country became relatively stable after the 2002 elections.
5
2.6% (1976 – 1986) , 1.5% (1986 – 1996)
4
COOPERATION STRATEGY - Lesotho 2 - Final.indd 4 2015/07/09 1:46 AMThe latest elections of 2012 were inconclusive as they saw no party winning
an absolute majority to form government. This resulted in formation of the
first three-party coalition government which is currently ruling.
For administrative purposes, Lesotho is divided into 10 districts: Berea, Butha-
Buthe, Leribe, Mafeteng, Maseru, Mohale’s Hoek, Mokhotlong, Thaba-Tseka,
Qacha’s Nek and Quthing. The constitution provides for an independent
judicial system. The judiciary is made up of the Court of Appeal, the High
Court, Magistrate’s Courts, and traditional courts that exist predominately
in rural areas. There is no trial by jury, rather, judges make rulings alone,
or, in the case of criminal trials, with two other judges as observers. The
constitution also protects basic civil liberties, including freedom of speech,
association, and the press; freedom of peaceful assembly; and freedom of
religion.
The legal system is based on English common law and Roman-Dutch law
with judicial review of legislative acts in High Court and Court of Appeal.
(Lesotho Judiciary, available on www.justice.gov.ls).
2.4 Socio-economic status
Lesotho is classified as one of the Least Developed Countries (LDC) with an
estimated income per capita of $1 000 and an annual economic growth rate
of 4.4%. The economic development of Lesotho has historically relied on
remittances from Basotho employed in South Africa, customs duties from the
Southern Africa Customs Union (SACU), and export revenue for the majority
of government revenue. However, the government has recently strengthened
its tax system to reduce dependency on customs duties.
As the world got into economic recession, Lesotho got affected too. Lesotho
became eligible for trade benefits under the Africa Growth and Opportunities
Act (AGOA) in 2000 and resumed exporting to the United States under
the same in 2001, with its textiles and clothing manufacturing sub-sector
growing substantially. However, the global economic crisis and the related
slump in consumer demand in the United States (US) resulted in the sub-
sector registering negative growth rates from 2007 to 2009 and recovered
only in 2010. It was estimated to have registered a lower growth rate of
4.4% in 2011 compared with 6.4% in 2010. The bulk of the products are
exported to the USA, therefore the slow recovery of the latter’s economy
and the associated low consumer demand resulted in a decline in orders for
Lesotho’s manufactured textiles, consequently, production had to be reduced
and some manufacturing firms had to close down operations in 2011.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 5
COOPERATION STRATEGY - Lesotho 2 - Final.indd 5 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
The textiles and clothing manufacturing sub-sector dominates Lesotho’s
manufacturing industry and makes a substantial contribution to employment
and economic growth in Lesotho. This industry has had the majority of
employees in the country. However, employment in the textiles sector
dropped by 10.4% in 2011 due to the aforementioned closure. Similarly,
employment in the public sector and South African mining industry dropped
by 0.1% and 0.3% respectively. (The Central Bank of Lesotho (CBL) Annual
report of 2006)
The 2008 Labour Force Survey Report records a 25% unemployment rate,
although the majority (71%) of those employed are in the informal sector,
where in-kind payments are common.
The findings of the 2009/2010 Agricultural Census indicate that agriculture
production, particularly production of major crops and livestock, fell quite
significantly in 2009/2010, compared to the two previous census years.
The drop in production over the years resulted in a situation where Lesotho
produced only 30.0% of its food requirements and the deficit had to be
imported. Food aid played a significant role in closing the gap. There are
a number of factors constraining agricultural production in Lesotho, such
as limited availability of arable land. The largest share of the population
resides in rural areas, with the majority relying heavily on agriculture for their
livelihoods. A decline in agricultural production therefore means aggravation
of the poverty challenge. (CBL Economic Review, December, 2011, No.137
available at: www.centralbank.org.ls/publication).
2.5 Social determinants of health
2.5.1 Socio-economic
In 2010, Lesotho ranked 141 out of 169 countries on the Human Development
Index (HDI), based on a value of 0.467. Despite the per capita of $1,000,
Lesotho’s poverty head count was put at 54%, according to the 2002/03
national household income survey.
2.5.2 Socio-cultural
The DHS of 2009 indicates that 94% of children of primary school age (age
6-12 years) attended primary school. Of this total, 92% were boys and 97%
girls. There seemed to be a strong positive relationship between household
6
COOPERATION STRATEGY - Lesotho 2 - Final.indd 6 2015/07/09 1:46 AMeconomic status and schooling. In 2012, KPMG also indicated that Lesotho
boasts high literacy levels, with an estimated 85% of the population aged 15
years and older considered as literate. Female literacy (94.5%) in Lesotho
remains higher than the male literacy rate.
2.5.3 Environmental
The 2009 DHS indicated that 80% of the population has access to improved
sources of water, with variation in the rural and urban areas, though the
latter is more advantaged. In general, 25% of households take no longer
than 30 minutes to get water from a supply source, while 23% have water
in their home. A programme of water quality surveillance that looks into the
structural integrity of drinking water facilities and the bacteriological quality
of potable water is in place within the Ministry of Health. The programme is,
however, not operating optimally to influence positive change management
including maintenance of drinking water supplies. Information generated is
not adequately used to predict potential hotspots for waterborne diseases.
Good household sanitation contributes to low infant mortality as it encourages
improved hygiene. The 2009 DHS found 24% of the population with improved
sanitation facilities, which mainly relate to availability and use of a toilet by
family members only, with the facility ensuring that there is no human contact
with waste.
While the country has no system for monitoring indoor and outdoor pollution,
it is noted that 73% of households use cooking fuel that potentially results
in air pollution (DHS 2009). The air pollution challenge is compounded by,
among others, an increasing use of motor vehicles, emissions from industrial
works and burning of wastes.
Waste management remains a challenge that needs to be addressed,
especially in urban areas and in health-care facilities across the country.
Lesotho has no formally licensed landfill sites and all waste is disposed at
unlicensed and/or informal dump sites (MCA-Lesotho, 2010). Some of the
waste disposed in these dump sites include ash from facilities for treating
health-care risk waste.
The country’s capacity to monitor all aspects of food safety still remains
limited. There is need to strengthen this capacity, taking into consideration
the serious public health risks posed by the consumption of unsafe food.
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 7
COOPERATION STRATEGY - Lesotho 2 - Final.indd 7 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
Table 1: Key socio-economic and demographic indicators
Indicators Value
Population size (De jure) 2006 1 880 661
Gender distribution (Females) 51.3%
Gender distribution (Males) 48.7%
Annual population growth 0.1%
Life expectancy at birth 42.2years
Total fertility rate 3.3 births
Literacy level (2012) 85%
Income per capita $1 000
Annual economic growth rate 4.4%
Unemployment rate (2008) 25%
Human Development Index(HDI) 141 out 169
Poverty head count (2002/03) 54%
Sources: Census 2006, KPMG 2012, Labour Force Survey Report 2008, National Income Survey 2002/03
2.6 Health status of the population
2.6.1 Maternal and child health
Lesotho health sector is faced with a number of challenges as indicated by
the high maternal mortality ratio which increased from 762 per 100 000 in
2004, to 1155 per 100 000 live births in 2009. The life-time risk of maternal
death is estimated at 1:32, implying that one out of 32 women in Lesotho will
die of pregnancy and childbirth-related conditions though there has been an
increase in the number of skilled birth attendance from 55% to 61% (DHS
2004, 2009). Maternal deaths due to pregnancy, childbirth and postpartum
complications, are on the increase, indicating low quality of maternal services,
coupled with high staff turnover.
Based on the 2010 maternal death report, there were 67 maternal deaths,
with obstetric haemorrhage being the leading cause of deaths (31%),
followed by complications of hypertension in pregnancy (25%). Pregnancy-
related sepsis was 3.3%, while non-pregnancy-related infections were the
8
COOPERATION STRATEGY - Lesotho 2 - Final.indd 8 2015/07/09 1:46 AMthird commonest cause (11.7%). Overall, 78.3% of maternal deaths were a
result of direct obstetric causes, while indirect causes accounted for 18.4% of
deaths. These leading causes of maternal mortality are preventable and can
be addressed by low-cost interventions. There has been a steady increase in
contraceptive prevalence rate from 35% to 47%, though the country has not
reached the 50% target for sub-Saharan Africa.
Infant mortality rate (IMR) is as high as 91 per 1 000 live births; under-five
mortality is 117 per 1 000 live births; and child mortality is 28 per 1 000 live
births (DHS 2009) are also high.
Recognizing the high burden of maternal and newborn ill-health on the
development capacity of individuals, families and communities, there is an
urgent need for provision of essential care during pregnancy, of skilled care
during childbirth and the immediate postpartum period;, and a few critical
interventions for neonates during the first days of life.
2.6.2 HIV and AIDS
The HIV epidemic remains the major health challenge and the most
important obstacle to sustainable human and socioeconomic development
in the Kingdom of Lesotho. The country has a generalized HIV epidemic and
registers the world’s third highest HIV prevalence; and the fifth highest TB-
HIV co-infection rates. The annual incidence is still at 2.47% and prevalence
at 23%. New infections and prevalence are higher among women than men
aged 15-49 years and prevalence is highest at over 40% among people aged
30-39 years. Among young people aged 20-24 years, HIV prevalence is also
high, estimated at 16.3%, while 4 000 children below age 14 years continue
to be infected with HIV every year.
The country continues to experience a serious health impact of the epidemic.
In 2012 about 23 000 adults and 4 000 children were newly infected, and
more than 250 000 adults and 37 000 children under the age of 14 years were
infected with HIV in 2013. Moreover, pregnant women who were estimated
to be with HIV was 14 763; 11, 000 women and men had HIV-TB co-infection.
Though AIDS-related mortality in Lesotho reduced from more than 21 000 in
2001 to less than 10 000 in 2013, only 60% who needed the life-saving ARV
medicine were receiving it. AIDS continues to be the highest cause of death
and accounted for 20% male, 22% female, and 8% child deaths in hospitals
(AJR 2013).
C O O P E R AT I O N S T R AT E G Y 2 0 1 4 - 2 0 1 9 9
COOPERATION STRATEGY - Lesotho 2 - Final.indd 9 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
2.6.2 Tuberculosis
Lesotho has the fifth highest estimated TB incidence in the world, with rates of
new TB cases estimated in 2012 at 630 TB patients per 100 000 populations
with incidence of sputum smear positive TB estimated at 281 TB cases per
100 000 population. TB notification rates have remained above 400 per 100
000 population.
TB burden remains huge in Lesotho, with prevalence of all types of TB
estimated at 424 cases per 100 000 population, and yet the TSR remains
low at 74% and contributes to a high TB mortality estimated at 17 deaths
per 100 000 annually. The majority of people with the disease who are
notified annually are in the young economically productive age group of 24-
35 years. This mirrors the HIV age distribution profile, suggesting continuing
transmission of infection rather than reactivation of old infection. About
80% of notified TB cases are also HIV positive. Other factors favouring
transmission of tuberculosis infection and progression to disease include
poverty, overcrowding, poor ventilation, alcoholism and poor nutrition as well
as the mining community.
2.6.3 Noncommunicable diseases
Tobacco use is another factor contributing to health risks, with tobacco
reportedly killing nearly 6 million people around the world each year. The
WHO STEPS survey on chronic disease risk factors was carried out in
Lesotho from April to May 2012, and to date, only preliminary results are
available. The findings indicated that about 25% of Basotho are currently
smoking, with majority being males (48.7%). WHO report on the global
tobacco epidemic of 2013 also portrays 39.3% prevalence of tobacco use
among the youth in Lesotho.
Overindulgence in toxic substances and unhealthy lifestyles are other health
challenges. Alcohol intake in Lesotho is reported at 31% according to the
preliminary results of the WHO STEPS survey, with men accounting for the
highest proportion. The same study indicated 83.8% of sampled population
with raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg) who were not on
medication. About 42% of people did not exercise regularly, and 92.7% of
them ate less than 5 servings of fruit and/or vegetables on average per day. .
Diabetes, one of the costly non-communicable diseases (NCDs), affects
people of all ages and is reported to be responsible for 4.5 million deaths
in the world in a year. The WHO STEPS survey reported prevalence of 4%
in Lesotho. It is among the top ten causes of disability, and can result in
10
COOPERATION STRATEGY - Lesotho 2 - Final.indd 10 2015/07/09 1:46 AMa number of life-threatening complications (AJR 2013/ Partnership, Mental
Newborn and Child Health – PMNCH 2013).
The Global Cancer Facts and Figures indicate that there were 7.6 million
deaths related to cancer in 2008, the majority of which were in the least
developed countries. It is estimated that the burden could be higher due to
currently adopted unhealthy lifestyles, such as smoking, physical inactivity,
and poor diet to mention a few. The WHO Global Burden of Disease estimates
also highlight that cancer accounts for 4% of deaths in Lesotho. Unfortunately
no accurate data on the burden is available in Lesotho.
Trauma remains the second main reason for admission of males in hospital,
after HIV and AIDS, with resultant death ranging from 3%-6% (AJR 2012).
Causes of trauma are mainly head injuries resulting from fights. According
to police data, injuries resulting from road traffic accidents are also on the
increase, with the burden mainly in the capital city, Maseru. The table below
reflects trends in some key health indicators.
Table 2: Trends in health indicators
Indicators 1976 1986 1996 2006 2004 2009 2011
Life Expectancy 51 53 59 41 41.02 41.84 50
IMR/1000 live Births 103 84 74 94 91 91 63
Child Mortality Rate/1000 - 34 34 24 24 28
U5 Mortality Rate/1 000 5 - - 113 113 117 86
MMR/100000 Births - 282 282 939 762 1155 620
Sources: Health Policy 2011 and WHO Health Statistics 2013
2.7 National response to overcoming
health challenges
In line with global and regional commitments, and in an effort to improve and
sustain the quality of life of the Basotho people, the NSDP of Lesotho places
halting and reversing the HIV and AIDS epidemic among its population high on
its development agenda. The country finances 70% of cost of ARV medicines
and will finance 100% of TB medicines, based on the 20% annual incremental
contribution from 0% in 2009. Lesotho has mobilized financial and technical
support from a number of partners towards achieving its MDG targets for HIV/
AIDS and TB. Below is an account of specific initiatives undertaken by the
government to address these challenges.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 - 2 0 1 9 11
COOPERATION STRATEGY - Lesotho 2 - Final.indd 11 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
The national responses to HIV and TB have been based on the NSDP, NHPSP,
the country‘s commitment to regional and global HIV/TB resolutions and
declarations; as well as the emerging global movement for Universal Health
Coverage with essential high impact health interventions and opportunities
brought about by developmental and technological innovations, with bearing
on the efficient delivery of HIV and TB prevention and control services.
Through the 2008–2012 National TB and Leprosy Plan and 2011-2015
National Strategic plan for HIV and AIDS, the country continued to pursue the
attainment of the Millennium Development Goals targets for HIV, AIDS and
TB control. A new national TB Strategic Plan 2013-2017 has been developed.
The country has achieved universal health facility coverage with HTC, PMTCT,
ART and TB DOTS services, and is scaling up interventions consistent with the
Global Health Sector Strategy on HIV/AIDS 2011-2015, as well as the STOP
TB Strategy. HIV, AIDS and TB control services are integrated in the Primary
Health Care (PHC) system and HIV/AIDS and anti-TB medicines are provided
free of charge to all patients, even in the non-state sectors. The government
has established partnerships with the Christian Health Association of Lesotho
(CHAL) for the management of HIV and TB patients and is seeking to expand
the scope to cover other private health-care providers.
The country has adopted the global HIV and TB policies, guidelines and tools
for service provision and management, including programme and disease
monitoring. HIV sentinel surveillance has been conducted every two years;
the last one was in 2011 and the latest for 2013 is in progress. In addition, HIV
surveillance was included in the LDHS, and provided useful population-based
data in 2004 and 2009. The next one is planned for 2014. However, the true
burden of TB is not yet known, as the first national TB prevalence survey is
only planned for 2014. The National policy provides for ambulatory treatment
of patients and treatment approaches are based on WHO/IUATLD guidelines
and recommendations.
HIV and TB diagnostic services have been expanding progressively, with all
the public health facilities able to provide rapid testing for HIV and microscopic
diagnosis for TB, including an innovative approach (“Riders for Health”) to get
laboratory specimens and results to and from health centres. The Government
is contributing 70% of funds needed for the purchase of ARV medicines, and
has been contributing progressively towards the procurement of first-line anti-
TB medicines from the Global Drug Facility, reaching 100% at the beginning of
2014. “Community-Based Support Group and “Community DOT Supporters’
initiatives are being widely implemented to improve treatment adherence.
12
COOPERATION STRATEGY - Lesotho 2 - Final.indd 12 2015/07/09 1:46 AMLesotho is running both hospital and community-based MDR-TB treatment
models. All DR-TB patients are systematically started on TB treatment or
both TB and ART for co-infected patients, within a short time of diagnosis.
The country has a well-developed laboratory capacity to diagnose MDR-TB,
using conventional technologies, and is rolling out new WHO-endorsed rapid
molecular tests to aid early diagnosis. All confirmed M/XDR-TB cases are able
to access free second-line anti-TB medicines and there have been no waiting
lists for treatment.
The following major issues and challenges still remain: True burden of TB in the
country is not yet known as no TB disease survey has ever been conducted;
Government resource allocation for HIV and TB control activities, including
human and financial resources, are not yet commensurate with the size of the
disease burden; the ART coverage and TB treatment success rates are still
fall far below the 80% and 87% of the global target respectively. This is mainly
due to low enrolment of people with HIV in treatment and poor retention into
treatment for both people with HIV and TB, attributed to high patient loss to
follow-up and death rates; HIV and TB diagnostics are still faced with frequent
shortage of HIV test kits and lack of microscopy services at some facilities,
as well as low coverage of Gene-Xpert technology due to the challenging
geographical terrain of the country.
There are still significant portions of the population without easy access to
essential HIV and TB diagnosis and treatment services, due to geographical
barriers, especially during rainy and winter seasons. Some health facilities,
especially at peripheral level, do not initiate treatment even for laboratory-
confirmed susceptible TB cases as well as for children with HIV. A vertical
model of DR-TB management is partner-run and driven, with minimal oversight
by the NTLP and the general primary health care system. The capacities of
designated laboratory to conduct DST for second-line anti-TB medicines and
access to culture and DST services by far located and rural health facilities is
still a challenge.
There is still limited functional collaborative linkage between the two
programmes at central and district policy levels, as well as in the service
delivery points/health facilities resulting in low coverage of ART among HIV/TB
co-infected patients. Patient monitoring tools for HIV and TB are not linked and
there is incomplete and unreliable recording on HIV and TB activities. Infection
control at health care facilities remains a challenge and most of them do not
have infection control plans.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 - 2 0 1 9 13
COOPERATION STRATEGY - Lesotho 2 - Final.indd 13 2015/07/09 1:46 AMWHO COUNTRY OFFICE LESOTHO
Lesotho employs a number of mechanisms to discourage unhealthy habits, and
tobacco is recognized as the most preventable cause of non-communicable
diseases. World No-Tobacco day is celebrated annually and a number of anti-
smoking campaigns are organized in the country. Lesotho ratified the WHO
Framework Convention on Tobacco Control (FCTC) in 2005, and the Tobacco
bill has been completed. The Anti-Drug and Alcohol Association of Lesotho
(ADAAL) which promotes student awareness against substance abuse in
high schools is in place. There is also a programme towards prevention of
alcohol use implemented with a Norwegian development non-governmental
organization.
In order to control high blood pressure and diabetes, health promotion
initiatives, through different types of media, have been employed to promote
screening of both diseases.
Cancer screening is one of the factors that control the disease burden,
therefore, access to PAP smears services has been availed in all the hospitals
and LPPA clinics for early detection of cervical cancer. The cervical cancer
screening programme was also launched at Senkatana at the beginning of
2013. Unfortunately to date, treatment is not yet provided in the country. As
one of the primary prevention approaches, in 2011, the MOH introduced a
HPV vaccine towards prevention of cervical cancer. This was piloted in two
districts before it was replicated in the remaining eight districts.
In May 2011, Lesotho launched a Decade of Road Safety which included
production of educational information on prevention of road traffic accidents.
Immunization is known as one of the most successful and cost-effective
public health investments that can save children’s lives. Thus immunization
can significantly contribute to achieving the MDG 4 relating to reduction of
child mortality, which aims to reduce under-five mortality by two thirds by 2015.
Several initiatives were therefore taken to improve immunization coverage.
Data Quality Self-Assessment (DQS) was conducted which led to identification
of four districts with high numbers of unimmunized children. Reaching Every
District (RED) training was conducted in the identified districts. Expanded
Programme on Immunization (EPI) recording and reporting tools were reviewed
to incorporate new vaccines. The national routine immunization by vaccine
showed the immunization coverage to be, on the average, 60%, which is far
less than the target of 90%. This is of great concern in perspective of achieving
the MDG target on immunization.
The country has a Disaster Management Authority (DMA) in preparedness
for emergencies. The Emergency Preparedness and Response (EPR) plan
exists but needs to be reviewed. The country also has an Integrated Disease
14
COOPERATION STRATEGY - Lesotho 2 - Final.indd 14 2015/07/09 1:46 AMSurveillance and Response (IDSR) in readiness for outbreaks. There is a
multi-sector Business Continuity Plan (BCP), which is not necessarily disease-
focused but covers all types of emergencies. It has been completed through
coordination by DMA, but is yet to be endorsed. Communication of emergencies
needs to improve as it sometimes is delayed. Multisectoral post-disaster needs
assessments are undertaken after each disaster to determine the effects and
required remedial actions. WHO partakes in health-related assessments.
3.3 UN Reforms Status and UNDAF Process
Historically, the health service delivery functioned within the Health
Service Areas (HSA) which divided the country into 18 zones. Following
decentralization, health service delivery is now assigned to ten administrative
districts of the country. Each district has at least one hospital. There are two
major health service providers namely, the Government of Lesotho (GOL)
and the Christian Health Association of Lesotho (CHAL) with ownership of
about 60% and 40% of the health institutions respectively. The table below
indicates the total number of health facilities by district and ownership.
Table 3: Summary of health facilities by ownership
# of # of # of
# of Health Total # of
Proprietor General Primary Filter
Centre Facilities
Hospitals Hospitals Clinics
GOL 12 0 83 4 99
CHAL 8 0 73 0 81
Red Cross 0 0 4 0 4
Private 1 4 47 0 52
GRAND TOTAL 21 4 207 4 236
Sources: Health facilities list 2013
The new state-of-the-art referral hospital, Queen ‘Mamohato Memorial
Hospital (QMMH) has been operational since October 2011, in replacement
of the old Queen Elizabeth II Hospital (QE II) through an innovative,
ground-breaking Public-Private Partnership (PPP). The hospital comes with
advanced equipment and additional services, such as the Intensive Care
Unit (ICU) and Neonatal ICU (NNICU), which were previously unavailable in
QE II.
C O O P E R A T I O N S T R A T E G Y 2 0 1 4 - 2 0 1 9 15
COOPERATION STRATEGY - Lesotho 2 - Final.indd 15 2015/07/09 1:46 AMYou can also read
