Lesotho has the third-highest rate of HIV infection in the world—almost a quarter of the adult population is HIV-positive. Lesotho’s mountains and harsh weather also restrict access to health services. People must walk an average of three to five hours over steep terrain to reach clinics. The life expectancy reflects these problems, sitting at only 40 years.

In 2006 Partners In Health began working in rural public clinics in the highlands to improve health services for people with HIV/AIDS.

By 2007 PIH and the Ministry of Health launched the first national treatment program for people with multidrug-resistant tuberculosis. The country was suffering from a growing epidemic and extremely high rates of HIV/tuberculosis co-infection. Since then, more than 1,000 patients have entered the program, which is based at Botsabelo Hospital in Maseru, a facility for critically-ill multidrug-resistant tuberculosis patients. The facility 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 a public tuberculosis reference laboratory in 2012, which allows cases of extensively drug-resistant tuberculosis to be identified without having to send samples outside of the country. It’s one of only two such state-of-the art testing facilities in southern Africa.

Like many poor countries, Lesotho has high rates of maternal mortality, so we also focus on ensuring mothers have 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 also treat young children with HIV, tuberculosis, and malnutrition. And we provide immunization, de-worming, and vitamin supplementation services.

In 2013 the Ministry of Health asked PIH to scale up our work to all of Lesotho—a multiyear national health care reform. We are now beginning to supervise and train clinical staff and health workers to provide high-quality care in clinics and communities across the country.