Find Health and Medical expertise in Lesotho

A network of hospitals, clinics and health centres provide basic facilities across most of the country. The Ministry of Health, in conjunction with several non-governmental and private agencies, as well as donors, maintains the health system. The country is divided into health service areas (HSAs), each of which has a government or mission hospital. The central hospital in each HSA works with village health centres that have resident nurses or nurse practitioners. The lowest tier of health delivery is clinics, which receive regular visits from doctors or nurses.

Serious emergencies are often referred to neighbouring South Africa. A new hospital, the Queen Mamohato Memorial, opened in 2011, replacing Queen Elizabeth II Hospital as the country’s only referral hospital. As there is no local pharmaceutical manufacturing, all pharmaceuticals are imported (2015).

Government expenditure

Just over a fifth of health care in Lesotho (21%) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Health care services in Lesotho are delivered primarily by the government and the Christian Health Association of Lesotho. Total health expenditure constituted 11.6% of GDP in 2012, of which 79% was covered by the government.

In 2013 government expenditure on health was 9.1% of GDP. In the most recent survey, conducted between 1997 and 2010, there were five doctors, and 62 nurses and midwives per 100,000 people. Additionally, in 2009, 62% of births were attended by qualified health staff and in 2013, 92% of one-year-olds were immunised with one dose of measles. In 2014, 82% people were using an improved drinking water source and 30% had access to adequate sanitation facilities.

Access to health services is difficult for many people, especially in rural areas. The country’s health system is also challenged by the relentless increase of the burden of disease brought about by HIV/AIDS, and a lack of expertise and human resources. However, efforts to reduce – and even eliminate – mother-to-child transmission of HIV have greatly improved the outlook for at-risk patients. The World Bank, Unicef and other charities have been working to support mothers with antenatal care, regardless of HIV status, throughout the country.

The country’s WHO Country Co-operation Strategic Agenda (2014–19) has identified the need to strengthen the health system’s capacity and performance as one of its strategic priorities. This includes looking for alternative health care financing to allow equitable access to health care, and enhancing national capacity to ensure access to quality essential medicines, vaccines and medical technologies.

Communicable and non-communicable diseases

Communicable diseases along with maternal, perinatal and nutritional conditions in Lesotho accounted for an estimated 64% of all mortality in 2012. The prevalence of HIV in Lesotho, as a percentage of people aged 15–49 years, stood at 22.9% in 2012. HIV prevalence rapidly increased during the 1990s and has remained at approximately 23% since the early 2000s. Lesotho is a non-endemic country for malaria, as a result of its high altitude. In the period 1990–2003 the estimated incidence of tuberculosis (TB) in the country saw a dramatic increase, decreasing slightly in 2003–12, with the 2013 rate recorded at 916 cases per 100,000 people. In the period 1990–2012 there was a slight overall decrease in estimated mortality from TB (when mortality data excludes cases comorbid with HIV). Non-communicable diseases (NCDs) in Lesotho accounted for an estimated 27% of all mortality in 2012. The most prevalent NCDs in Lesotho are cardiovascular diseases, which accounted for 12% of total deaths across all age groups in 2012. Non-communicable variants of respiratory diseases, cancer and diabetes contributed 4%, 3% and 3%, respectively (2012).

Infant mortality in Lesotho was 71 deaths per 1,000 live births in 2014, with an under-five mortality rate of 98 deaths per 1,000 live births in 2013. The under-five mortality rate peaked in the period 2004–05 and remains above the rate recorded for 1990. As a result, the under-five mortality rate has not yet reached the country’s target of 29 deaths per 1,000 live births, as defined by Millennium Development Goal 4 (MDG 4). In 2010 the most prominent causes of death for children below the age of five years were HIV/AIDS (19%), prematurity (16%), intrapartum-related complications (14%) and acute respiratory infections (12%). Other contributory causes were neonatal sepsis (8%), diarrhoea (7%) injuries (4%), congenital anomalies (4%) and measles (1%). In 2013 Lesotho had an adjusted maternal mortality ratio of 490 deaths per 100,000 live births (this figure was estimated at 620 deaths per 100,000 by UN agencies/World bank in 2010).

Lesotho was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1992 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.

Pharmaceutical companies within Lesotho include Allied Chemist Pty Ltd, Dodapharma Pty Ltd, and Parkside Pharmaceuticals.

The government of Lesotho’s Department of Pharmaceutical Services is responsible for distributing pharmaceuticals to all hospitals and health centres in Lesotho. The National Drug Services Organization is in charge of the procurement and distribution of pharmaceuticals throughout the health system. Manufacturing and testing are also handled by the government.

According to the Southern African Customs Union, imports of pharmaceutical products represented 2.8% of the country’s total imports for 2010 (SACU, 2010).

The most recent survey, conducted in the period 2000–11, reports that Lesotho has three pharmaceutical personnel per 100,000 people.