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Commonwealth Health Partnerships 2015

C ommo nwe a l t h memb e r c o u n t r i e s For Lesotho to achieve its targets for the reduction of child mortality, which forms MDG 4, it would need to have reduced under-five deaths per 1,000 live births to 29 and increased measles immunisation to 100 per cent when the 2015 data has been analysed. In 2013 under-five mortality stood at 98 deaths per 1,000 live births – three times the target figure – and measles immunisation at 92 per cent. Consequently, Lesotho is unlikely to achieve MDG 4 by 2015. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Lesotho, maternal mortality should fall to 130 cases per 100,000 live births. 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). Based on the data reported by the country, the achievement of this target is unlikely. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2009 this figure stood at 62 per cent, so it is unlikely that this target will be achieved. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other communicable diseases. Lesotho’s prevalence of HIV was 22.9 per cent in 2012 (in the 15–49 age group). This figure is extremely high and there has been no significant reduction in HIV prevalence since the advent of the disease in the 1980s. The country also has a high incidence of tuberculosis (TB), which is estimated to have increased significantly in the period 1990–2012, although estimated mortality (when mortality data excludes cases comorbid with HIV) from TB has fallen slightly during this time. Accordingly, the targets for MDG 6 are unlikely to be met. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Just over a fifth of health care in Lesotho (21 per cent) 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 per cent of GDP in 2012, of which 79 per cent (US$108 per capita) was covered by the government. 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. 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. Care of the elderly: Around 87,000 people in Lesotho are over the age of 65 – four per cent of the total population (2013). At the age of 60 a person living in Lesotho can be expected to live for an additional 15 years, on average (2013). Lesotho’s old-age pension dates back to 2004. Monthly pension credits are paid at a rate of US$4 per person (2007–12) on a pensions-tested basis. HelpAge International has been working with local affiliates to provide eye care for the elderly and improve their quality of life through arranged visits, activities and programmes. Further information Lesotho Medical Association: www.lma.org.ls Ministry of Health and Social Welfare: www.gov.ls Commonwealth Health Online: www.commonwealthhealth.org/health/africa/lesotho 198 Commonwealth Health Partnerships 2015 Population over 65 4%


Commonwealth Health Partnerships 2015
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