The rate of HIV infection among adults in Lesotho is one of the highest in the world at 23 percent. And as HIV has taken its toll, the country has also suffered rising rates of maternal mortality, poor child health, and tuberculosis. To reach health services, people struggle through harsh weather and mountainous terrain, walking an average of four hours to reach clinics. Without enough staff and resources, doctors struggle to cope. Life expectancy reflects these problems, peaking at only 49 years.

Lesotho’s health system needs a powerful and long-lasting solution. Known locally as Bo-Mphato Litšebeletsong tsa Bophelo, Partners In Health began working in Lesotho in 2006 at the invitation of the Ministry of Health. Our first task was to improve public health centers in the rural highlands where people with HIV/AIDS had very few options for treatment. In the years that followed we enrolled 7,000 patients in an HIV program. In 2013 the Ministry of Health asked PIH to scale up our work across all of Lesotho—a multiyear national health care reform. We are now beginning to supervise and train clinical staff and community health workers to provide high-quality care in clinics and communities across the country.

We saw early on that the country also faced a growing epidemic of multidrug-resistant tuberculosis, and in 2007 we launched the first-ever national treatment program. Since then, more than 1,000 patients have entered the program, which is based at Botsabelo Hospital in Maseru, a facility for critically-ill patients. The hospital also serves as a training center for clinicians from throughout Africa who come to learn about the management of multidrug-resistant tuberculosis and HIV/tuberculosis co-infection.

We completed construction of the country’s first public tuberculosis reference laboratory in 2012. Here cases of extensively drug-resistant tuberculosis, an even more severe form of the disease, can be identified without sending samples outside of the country. It’s one of only two such state-of-the art testing facilities in southern Africa.

Lesotho has high rates of maternal mortality, and so we focus on providing mothers essential care during pregnancy. We train community health workers to regularly visit pregnant women at home to check on their health, and to accompany them to health centers for care before, during, and after delivering their babies. At the same time, we treat young children with HIV, tuberculosis, and malnutrition, and we provide them immunizations, de-worming treatments, and vitamins.