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Lesotho

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Endemic/epidemic disease | Healthcare exclusion

After nearly a decade of working in Lesotho, Doctors Without Borders (MSF) handed over all its projects to the government in November 2015.Lesotho is a mountainous, landlocked country with few roads, where many people face barriers in accessing care – not only because of the cost of travelling to health facilities, but also because of the shortage of skilled health workers.

During its time in the country, MSF focused mainly on providing free maternal care to women, as well as family planning and HIV treatment. There is a high prevalence of HIV in Lesotho – it is 27 per cent among pregnant women – and this, along with tuberculosis (TB) co-infection, contributes to high rates of maternal death.Family planning services, ante- and postnatal care were offered at the MSF-supported St Joseph’s district hospital in Roma, six health clinics in the lowlands and three clinics in remote Semonkong.

Within a year of MSF covering all expenses for antenatal care and deliveries at St Joseph’s Hospital, the number of women giving birth there increased by 45 per cent. During 2015 an average of 130 babies were being delivered there every month.

MSF also trained and mentored local staff at these facilities in how to provide integrated care for patients co-infected with HIV and TB. Local counsellors and community health workers initiated and followed up antiretroviral (ARV) treatment. Viral load monitoring was also expanded, and lay counsellors were trained to deliver adherence counselling to help patients understand the importance of sticking to their ARV treatment. As a result, by the time MSF left, over 80 per cent of first-line ARV patients had attained virological suppression.

UNICEF has now taken over the funding of free maternal care at St Joseph’s Hospital, and MSF continues to advocate for the national rollout of free maternal care in Lesotho.

Year MSF first worked in the country: 2006