The Problem

Despite its status as a middle-income country, Lesotho struggles with some of the world’s highest rates in mortality from HIV, TB and preventable maternal and child health conditions.  The country’s public health system is also failing to provide adequate coverage of basic health services, particularly in the mountainous and remote regions of the country.  This is due to a combination of weak management at district and facility levels, large capacity gaps in the health workforce, and lack of coordination between the public sector, international NGOs, and donors.

In 2014, the government of Lesotho, supported by Partners in Health, began a pilot effort in four districts to scale up access to essential primary health care services and improve coverage and improve health outcomes, especially those related to HIV, TB, maternal and child mortality. The decentralized primary health care model is being implemented through a combination of village health workers scale-up and empowering district health management teams to deliver health care at the community level, plus strengthening of basic health infrastructure.  The initial results of the pilot have been striking, with markedly greater utilization of health services at local health centers, reductions in home-births, and increases in child vaccinations, antenatal care, and HIV/TB treatment.

The Government of Lesotho is now seeking to scale-up the pilot programs to the remaining six districts, and to strengthen leadership and accountability for health outcomes at all levels of government.  This means developing a scale up strategy and plan and costing it; engaging multiple the ministries of health and local government, traditional leaders and chiefs, and the top political officials from the prime minister’s office; and bringing on board international NGOs and donors as full partners in the reform scale up.

The Pharos Solution​

Pharos has provided support to the Government of Lesotho by developing their national primary health care leadership reform policy, an initiative that was formally launched by the Prime Minister of Lesotho on August 25th, 2016.  Pharos also costed the scale-up of the reform effort, which will serve as a critical input to mobilizing the necessary resources and coordinating donor and partner activity to increase access to essential primary health care services.  The full strategy document was delivered to the Government at the end of October and was recently endorsed by the Ministry of Health.

Looking Ahead

Efforts are now under way to mobilize funds to implement the strategy in 2017. A series of consultations within government, including with the finance ministry, and with the major international donor agencies such as the Global Fund and PEPFAR, are also envisioned to mobilize additional resources to implement the reform. The Lesotho government also has financial and human resources that can be deployed, despite the tight budget constraints it faces, for example by reallocating parts of the budget for primary health care that are currently being underspent. A thorough independent evaluation of the PIH-based pilot might also help to reinforce advocacy for the large scale roll out both within the Government and with donors.

Status: Completed in October 2016

Team members involved: Shan Soe-Lin, Dave Matheson (Matheson Consulting), Gabriel Seidman (Harvard School of Public Health), Tendayi Chipango, Robert Hecht

For more information, contact Robert Hecht at

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