Located in Southern Africa, Lesotho lies on the highest part of Drakensberg escarpment and is divided into four agro-ecological zones; the lowlands, the foothills, mountains, and the Senqu River valley according to “Analysis of Traditional Healers in Lesotho: Implications on Intellectual Property Systems” by Masupha, Thamae, and Phaqane (2012). The article “Lesotho” (2017) discusses how they are completely surrounded by South Africa and can be described as “The Hostage State” due to being completely dependent on the Republic of South Africa. The area is called The Kingdom of Lesotho, formerly known as Basutoland. The nation was formed in the early 1800s where both names were derived from the commonly spoken language of Sotho.
Lesotho is the second highest human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) hot-spot and one of the poorest and least developed countries in the world. Ever since the discovery in 1986, the Lesotho community has begun to quickly deteriorate. The people of Lesotho are referred to as Basotho (plural) and Mosotho (singular). In 1998, the population was estimated to be 2,089,289 with a growth rate of 1.9 percent. Due to the rapid HIV/AIDS crisis, this could have a large impact on the population by the end of the twentieth century. Since the crisis of HIV/AIDS has escalated, Lesotho has received economic and social welfare aid from countries including the United States, the United Kingdom, the European Union, and Germany. They also receive assistance from The Joint United Nations Programme on HIV and AIDS (UNAIDS) as well as the United States Peace Corps who have been actively helping since 1966. The volunteers work in the fields of agriculture, education, rural development, women’s issues, and the environment (“Lesotho”,2017).
“Lesotho” (2017) continues to describe that aside from the HIV/AIDS crisis, the country is generally healthy. Health centers, mountain dispensaries, and traditional medical practitioners are available and primarily used by the village population. Primary health care was adopted in 1979 which included community health workers to help focus on health promotion. Having community health workers is an efficient yet effective intervention central that increases community-based health services especially in underserved areas. “Community health workers in Lesotho: Experiences of health promotion activities” by Seutloali, Naploes, and Bam (2018) stated, “Although the scope of their work may vary from one country to another, they generally share similar core roles which consist of disease prevention and early detection of ill-health, community advocacy, outreach services, home visits, assisting in accessing services through referrals and follow-ups, treatment of minor ailments by administering basic first aid and providing psycho-social support through support groups.” Seutloali, Naploes, and Bam continue to explain that community health care workers have comprehensive knowledge of the communities they are working amongst which makes them effective health promotion agents. Due to the heavy burden of HIV/AIDS and tuberculosis, the health care resources shifted from health promotion to home-based care. Home-based care allows for the burden to be taken off of the family members especially if they are not familiar with the ways in which the disease can be transmitted. Also, the immediate family can be educated and given resources from the health care workers.
The article “Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho” by Masebeo Veronica Koto and Pranitha Maharaj (2016) discusses that since the first case of HIV was identified in 1986 the numbers have steadily increased spreading rapidly to both rural and urban areas of the country. Between the years of 2005-2013, the number of people living with HIV increased from 270,000 to 360,000. A study, “Exploring the views of health care service providers on life stressors and basic needs of HIV-positive mothers in rural areas of Lesotho” by Shoeshoe Mofokeng and Sulina Green (2017) states that of the 360,000 people diagnosed at that time with HIV, 340,000 of them are women. Mofokeng and Green (2017) continue to talk about the limited number of support systems that reach the rural communities that address life stressors and the basic needs of HIV-positive mothers. Although there are a limited number of support systems, a few do exist such as the Elizabeth Glassier Foundation and a mother-to-mother organization. Within both groups, free prevention guidance, care and treatment services, and door-to-door visits from health care workers that offer psychosocial support are provided. According to Mofokeng and Green (2017), “HIV is one of the most serious critical life issues that a person can experience in that it affects not only the physical wellbeing but also the resources of its host.”
Koto and Maharaj (2016) continue explaining that although AIDS had a later arrival, it accounts for 56% of deaths in children under the age of five and is responsible for the decline of life expectancy which undermines many of the developmental gains Lesotho was achieving. The research article, “Estimating the cost of diagnosing HIV at birth in Lesotho” by Tchuenche, Gill, Bollinger, Mofenson, Phalatse, Nchephe, Mokone, Tukei, Tiam, and Forsythe (2018) report how HIV progresses more rapidly in children than in adults. Care is critical within the first few weeks of life in order to reduce mortality. The research done by Tchuenche et al. (2018) showed reports of mortality rising within the first 8-12 weeks of life and directly stating, “Early initiation of treatment between ages 6 and 12 weeks has been shown to dramatically reduce infant mortality by 76%.” According to “Lesotho Health Network Public-private Partnership” (2016), nearly one in every nine children die before they reach their fifth birthday due to a 74% HIV infection rate.
The large pandemic of AIDS has lead to a shortage in health care workers with roughly 60% of professional nursing posts vacant and less than 100 physicians working in the country (Koto & Maharaj, 2016). “Healthcare providers’ attitudes and perceptions in infection diagnosis and antibiotic prescribing in public health institutions in Lesotho: a cross-sectional survey” by Adorka, Dikokole, Mitonga, and Allen (2013) explain in their study that certain healthcare workers aren’t willing to or inaccurately prescribe antibiotics based off of their own attitudes and perceptions. In specific cases where healthcare providers are inadequately prescribing antibiotics to patients, should be required to take refresher education courses emphasizing on topics such as infection diagnosis and prescribing antibiotics. These courses should be renewed every 2 years to stay up to date with new and improved antibiotics, especially since most patients in Lesotho present open infections with the need to be taken care of correctly to stop the process of further bacterial infections. There is an understanding of the health care workers behalf of not wanting to come in contact with such diseases however, they did take an oath to uphold ethical procedures and provide optimal care to all patients.
A large majority of Africans use traditional healers for their primary health care because they are easily accessible, affordable, adaptable, trusted, culturally familiar, and respected throughout the community. Since prehistoric times, the country’s traditional healers have healed the sick, driven away evil spirits, and protected animals and plants. When HIV/AIDS emerged, the traditional healers related the disease to witchcraft and sought out to cure with herbal remedies. As well as being the preferred method of treatment, due to the culture’s wide belief system, they are able to treat most STD cases which is a major co-factor in spreading HIV (Masupha, Thamae, & Phaqane, 2013).
In order to provide Lesotho with a high level of healthcare services, community health workers need to continue their work that is already being provided. They allow a form of transportation to other facilities for the ill and offer a larger range of access to other health care services. Being Lesotho does not have enough workers directly within the country, the health care workers could work on transporting the patients to a different country in order to accommodate the extra help that is needed. The main concern of current health care workers is their worry of catching HIV/AIDS due to the lack of supplies available to them such as gloves and sterile needles. New supplies could be donated by hospitals or other health care programs that already have enough to help the countries that are desperately in need. Since a majority of the HIV positive population is made up of women, more local support services and/or organizations need to be created in order to help infected mothers of the community care for themselves as well as their child in a safe way. Current health care providers can inform currently HIV-positive mothers about door-to-door visitation services and other support groups to help assist each other (Mofokeng & Green, 2017). These support groups and services should be provided at home or a walking distance away for those who cannot afford transportation.
The journal, “Notes from the Field: HIV Testing in Health Care Facilities” by Isavwa, Letsie, and Ramphalla (2017) states that HIV is the leading cause of premature death in Lesotho, which includes AIDS, contributes to the country having the shortest life expectancy at birth. “The President's Emergency Plan for AIDS Relief (PEPFAR) supports HIV testing in 121 health care facilities in five of Lesotho’s districts.” continues Isavwa, Letsie, and Ramphalla (2017). Being that action has already taken place, Lesotho has achieved almost 100% HIV testing coverage due to PEPFAR- supported facilities. Testing needs to be expanded to the families of those who are HIV-positive which could be done in a facility, community-based, or by self-testing. In order for Lesotho to gain complete control HIV testing needs to have service coverage available at all facilities (Isavwa, Letsie, and Ramphalla, 2017). Another way for Lesotho to gain more control over the HIV/AIDS epidemic would be to open clinics, or have separate wings, directed towards men and adolescents care. A community outreach program could be developed for those to attend who are part of the underserved population, so they can gain knowledge, preventative care, and receive free contraceptives for future protection.
The Government of Lesotho has been working with the World Bank group on strengthening its public health system to provide optimal care for the citizens. They contracted a public-private partnership (PPP) to transform the operations of facilities, improve quality of care, and build capacity in the public health system. The facilities provide care to more than 25% of Lesotho’s population and have dramatically improved maternal and child health results. Since offering health care through primary clinics many patients have sought treatment there rather than going to the hospital. Lesotho offers universal health care for all citizens and even though the patients are paying the same the same fee for care at both places, PPP and hospitals, the choice is made by the quality of care the patients receive from the PPP (“Lesotho”, 2016). Although partnering with PPP comes with many benefits it also brought on a large financial burden. The Government of Lesotho could pitch their point to other countries of how they desperately need these new facilities but don’t have the funding and neither do the patients. Receiving grants would be a good start in helping reverse the country’s health budget.
Eltony Mugomeri (2018) published an article titled, “The efficacy of infection prevention and control committees in Lesotho: A qualitative study” that went into detail about the infection prevention and control (IPC) committee within the country to determine the effectiveness. Although they received complete commitment the IPC committee was deemed ineffective because of 5 major barriers; poor sense of competence, administrative constraints, inadequate financial support, role uncertainty, and negative staff attitudes. The IPC committees can be improved immensely by prioritizing the development of leadership roles and addressing the IPC training framework. They should be setting up policies and providing new input ideas on how to address infections to all staff, patients, and visitors.
Developing countries deserve to have the same right and opportunity to receive optimal health care as other developed countries do. Although funding is one of the main issues, there are different ways to provide care. Volunteer groups, grants, free clinics, and continuation of the government working with health systems like the public-private partnership are a few ways that should and continue to be implemented in order to improve the HIV/AIDS epidemic within Lesotho.