1. Lesotho
A Review of the Health System in Lesotho

3. Area: 30,355 km2
Population: 2,067,000
(2009 estimate)
Capital: Maseru
( population: 200,000)

4. • Lesotho, is a small rural
country in Africa that is a
true enclave; it is
completely surrounded
by South Africa.
• This mountainous country
is home to the Basotho
people.
• Altitudes in Lesotho range
from 4,500 to over 13,000
feet.
• High mountains cover
about two thirds of the
country.

5. • The capital city Maseru has a population of
approximately 200,000, and is home to the main
government hospital in Lesotho.
• The remainder of Lesotho’s 2 million people live in
small rural towns with the majority (81%) of the
population living in remote rural villages.

6. Health Services in
Lesotho
• Healthcare delivery in Lesotho is challenging as a
result of the fact that 81% of the population lives in
remote rural villages, often several hours walk over
rough mountain paths from the nearest clinic.
• Access to healthcare in Lesotho is also limited by
poverty and by lack of personnel.
• Citizens pay directly at the point of service for their
healthcare.

7. • Lesotho achieved great strides in improving its
health indicators from 1966 to 1990, with life
expectancy rising from 40 years to 59 years.
• However, Lesotho has been devastated by
HIV/AIDS, which has reversed the gains the country
achieved in health indicators (with life expectancy
dropping to age 44 in 2008, from age 59) (World
Bank 2010), reduced the population growth
rate, and left no sector of the economy unaffected.

8. The formal system of Lesotho health facilities are
divided into:
• National (tertiary) 3
• one referral and two specialized hospitals. Any
patients with conditions that cannot be addressed
at the national level are referred to South Africa.
• District(secondary) 18
• Hospitals that receive patients referred from the
community level and filter clinics.
• Community (primary) levels 188
• includes both health posts and health centers

9. • 42% of the health centers and 58%of the hospitals
are government owned.
• 38% of the hospitals and 38% of the health centers
fall under the control of the Christian Health
Association of Lesotho (CHAL), and the remaining
facilities are either privately owned or operated by
the Lesotho Red Cross.

11. National Level
• At the national level, Lesotho has three tertiary-level
hospitals:
• Queen Elizabeth II Hospital
• Mohlomi Mental Hospital
• Bots`abelo Leprosy Hospital.
• Queen Elizabeth II Hospital is the national referral
hospital. Any cases that cannot be treated at Queen
Elizabeth II are referred to South Africa.
• There is a fourth, large tertiary hospital in the process of
being built through a public-private partnership. This will
serve as the main referral hospital in Lesotho. It will be
substantially larger than Queen Elizabeth II Hospital.

12. • Health posts are run by volunteer community health
workers and provide outreach type care, such as
condom distribution and immunizations.
• Health centers are staffed by nurse clinicians, who
provide outpatient primary care.
• The large district hospitals provide a variety of
outpatient services, including both primary care
and specialized clinics (such as HIV/AIDS
• and TB clinics), as well as inpatient services.

13. St Josephs Hospital , Roma
, built in 1937 as 5 separate
single storey buildings. It is a
district hospital that serves
a population of 120,000 and
is 40 km from Maseru the
Capital.
The Hospital is in a very
mountainous area and is in
poor physical
condition, with serious roof
leaks and the consequential
damage to the ward
ceilings, floors and
paintwork.
Working with the hospital
maintenance staff we
completely refurbished 2
hospital wards .

14. Health Expenditure
• Lesotho spent an average of 7.7 percent of its GDP on health
between 2004/05 and 2008/09 reaching a peak of 8.5 percent
of its GDP in 2008/09, which is almost double the average for
low middle income group countries (4.5 percent), and well
above the (WHO) African Region average of 5.6 percent in
2006.
• In per capita terms, there has also been an upward increase
from a low US$45.5 from 2004/05 to a high of US$66.3 in
2007/08.
• From 2004/5 to 2008/9, Lesotho spent US$54.6 per capita/per
annum, which was one and one-half times higher than the
US$34 per capita per annum recommended for providing a
minimum package of cost-effective interventions..

15. • This implies that Lesotho is not suffering from an
absolute inadequacy of financial resources, but
that the country has, and allocates, resources
capable of providing quality health care services to
its population.
• However, this amount, while double the WHO
African Region average ($27/annum), remains
lower than the average of its peers in the low
middle income group ($74) (WHO 2009)

16. 3,222
3851
3867
7164
2817
4150
119
1282
0 2,000 4,000 6,000 8,000
United Kingdom
France
Germany
United States
Japan
Australia
Lesotho
Bahrain
Health expenditure per capita (2008) in
comaprsion Globally
Health expenditure per capita
(2008) in comaprsion Globally

17. 119
843
147
113
66
86
1053
899
Lesotho
South Africa
Sudan
Nigeria
Kenya
Chad
Botswana
Globally
Health Expenditure per Capita in comparison
to African Countries
Health Expenditure per Capita in comparison to African Countries

18. Health
Expenditure, % of
total GDP
($2 ,179, 350,967
2007-2011: 11.1%
2002-2006 9.4%

19. •Human Resources
• Based on last available WHO data
2000)
• Physicians
• Lesotho 0.5/10,000
• Regional 2.3/10,000
• Nurses & Midwives:
• Lesotho 6.2/10,000
• Regional 10.9/10,000
(

20. In comparison to Bahrain:
• Indicators per 10,000 population
Physicians
• 1997: 14.2
• 2007: 21.4
• Nurses & Midwives
• 1997 28.2
• 2007 41.9

21. • Contributing to Lesotho’s difficulties with retaining
medical personnel, is the fact that Lesotho has no
formal medical education aside from nursing
schools.
• Most Basotho who attend medical school do so in
South Africa, & few return to practice in their
country.

22. Basic Demographics

23. HIV/AIDS in Lesotho:
• Lesotho has the third highest HIV prevalence in the
world - just under one in four people in the country
are living with HIV.
• In 2009 there were around 23,000 new HIV infections
and approximately 14,000 people died from AIDS.
• Over half of the 260,000 adults living with HIV in
Lesotho are women.
• “There are two types of people in Lesotho; those
infected and those affected by HIV/AIDS”.

24. • The majority of HIV transmission is heterosexual and
mother to child.
• Reasons for high HIV rates are multi-
factorial, including poverty, social instability, high
levels of other STDs, sexual violence and high
mobility (particularly migrant labor)

25. • The AIDS epidemic in Lesotho has had a
devastating impact on the country. Crippling
poverty combined with AIDS has caused average
life expectancy to drop to 48.2 years. The impact
on individuals, families and the whole nation is
being felt as adults become too sick to work, and
children orphaned by AIDS.

29. Lesotho’s AIDS effort is now
guided by the National AIDS
Policy and Strategic Plan for
2006-2011.
The government intends to
reverse the epidemic by
focusing on HIV prevention
through condom
promotion, prevention of
mother-to-child
transmission, and
providing antiretroviral
treatment for all those in
need

31. Tuberculosis
• Lesotho also suffers from one of the highest rates
of tuberculosis infection in the world (634 new cases
per 100,000 per year, compared to just 4 per
100,000 in the U.S.)
• The majority of people infected with TB in Lesotho
are also HIV-positive and nearly 1,000 people each
year contract strains of TB that are resistant to all
first-line drugs.

33. • According to Lesotho’s Ministry of health:
• TB accounts for 31% of institutional deaths
• pneumonia 29%
• diarrheal diseases14%
• HIV/AIDS (which clearly contribute to the above causes of death as
well)9%
• Pneumoconiosis associated with pulmonary TB 6%
• Upper respiratory infection 5%
• Diabetes 3%
• Head injury 3%
• Incomplete abortion 0.5%.
• Nutrition is also a major cause of disease in Lesotho, especially
• affecting children, with 13% of inpatient admissions resulting from
• nutritional deficiencies in children aged 0-4 and 3.5% of admissions
• for all age groups.

35. Areas for future
improvement
• Medical care in Lesotho is largely framed by the
nation’s challenges with HIV/AIDS, TB, poverty and
topography.
• There are many potential interventions that may be
taken in order to improve health outcomes.
• The most important factors in improving health in
Lesotho are reducing poverty and increasing
access to primary/preventative care, such as
access to free/low cost ART and TB
• treatments.

36. • Improvements to roads and transportation
infrastructure would likely have the largest impact
on Lesotho’s pre-hospital care. The development of
a pre-hospital medical system with a centralized
ambulance service and trained medical personnel
may make a significant impact on health outcomes
in densely populated areas of Lesotho.

37. • Recently, a residency program in family medicine
was started, which will hopefully lead to better
retention of doctors in Lesotho.
• With these efforts and continuation of HIV/AIDS and
TB prevention and treatment campaigns, Lesotho
should have continued increase in average lifespan
and improved health outcomes.