Partners In Health (Lesotho)
Partners In Health (PIH) arrived in Lesotho in June 2006, and has been providing clinical support, training for nurses and village health workers and supervised community-based treatment for HIV/AIDS and TB. Other services offered at the health centres include prevention of mother-to-child transmission of HIV (PMTCT), vaccinations, and family planning. With help from an agreement with the World Food Program, PIH is also providing nutritional support for HIV and TB patients, pregnant women, malnourished children and others who show clinical signs of malnutrition.
Approximately one quarter of Lesotho's adult population is HIV-positive and life expectancy in the tiny mountain kingdom has plummeted to less than 40 years. In addition, the Basotho people are being ravaged by a second epidemic. Lesotho's TB rate is among the highest in the world, and TB spreads rapidly and is particularly deadly where many people's immune systems are weakened by HIV. The PIH project in Lesotho was then launched in 2006 following an invitation from the government of Lesotho and consultation with our partners in Rwanda, the Clinton HIV/AIDS Initiative (CHAI, now known as the Clinton Health Access Initiative), about where to replicate that successful model elsewhere in Africa.
As in Rwanda, PIH began with a focus on bringing HIV and TB care and treatment to poor, rural communities that have largely been neglected by other AIDS programs and non-governmental organizations. In the case of Lesotho, that means remote villages high in the mountains that are often accessible only by single-engine propeller aircraft or by rough dirt roads carved into the mountains. To reach the Lebakeng health centre by land, people and supplies must be transported across the river and then complete the journey by donkey or horseback.
PIH has a central office located in the capital of Maseru which coordinates logistics, procurement and communications for a network of 7 remote rural health centers: Nohana, Bobete, Nkau, Lebakeng, Tlhanyaku, Methalaneng, and Manamaneng. These serve a combined population of more than 175,000 people. Transport of people and supplies is supported through partnerships with the Lesotho Flying Doctors Service (supported by the Ministry of Health and Social Welfare) and Mission Aviation Fellowship.
Prior to the launch of the PIH MDR-TB project in Lesotho, the country lacked the resources to diagnose drug-resistant TB and monitor its prevalence.
In 2007, PIH focused on refurbishing the national TB laboratory and opening a new MDR-TB hospital in the capital city, Maseru. Previously a leprosy hospital, Botsabelo Hospital was converted into a 20-bed facility for the treatment of critically ill MDR-TB and MDR-TB/HIV coinfected patients, so that they can receive round-the-clock care.
This facility also serves as PIH's centre for training doctors and nurses from throughout Africa in the management of MDR-TB/HIV coinfection. The first patients were admitted to the hospital at the end of September 2007 and since then the facility has been consistently filled to capacity.
At the same time that the hospital was being renovated, PIH also launched MDR-TB treatment at the community level.
As PIH has done elsewhere, MDR-TB treatment is mostly provided at the community level, supported by paid and carefully trained community health workers who visit patients in their homes twice a day. Those patients who are very sick and require immediate clinical care are hospitalized at Botsabelo Hospital and discharged after improvement. Others are not admitted to the hospital but require frequent clinical visits to Maseru. Those who live too far away to make regular trips to the capital city are housed in PIH-supported temporary houses until they are stabilized and can be returned home to continue care in their own community.
By the end of 2007, 42 MDR-TB patients were enrolled on therapy. As of the start of 2011, more than 500 patients have entered the treatment program for MDR-TB.
In 2009, with support from the Elton John AIDS Foundation, PIH began a pilot project at the Bobete health centre to increase services to pregnant women. The health centre, in consultation with the villages, selected 100 traditional birth attendants (TBAs) to be trained as specialized community health workers. These TBA/CHWs are responsible for identifying and counselling women in their villages about the importance of antenatal care (ANC) and delivery at the health centre. TBAs receive incentives to accompany pregnant women to the health centre for comprehensive ANC, which includes testing and treatment for HIV, STIs and anaemia, and to accompany women for delivery at the health centre. Because women generally live a long walk from the clinic, waiting houses near the health centre provide temporary shelter in the week leading up to delivery. This project has significantly increased pregnant women's uptake of available services. In 2010, the Bobete health centre saw almost 1,000 pregnant women for ANC and delivered 180 babies. With support from the Positive Action for Children Fund, PIH Lesotho is expanding this project to six other health centres, as it is an important part of our efforts to reduce maternal mortality and improve early childhood survival, in addition to connecting women and families to critical PMTCT, vaccination, family planning and other health services.
Rural clinics in the southern African country of Lesotho used to deliver an average of three or four babies per month, with most mothers delivering their infants at home, risking the possible severe health and disease transmission threats. Now, some of those same clinics are delivering over two dozen infants each month thanks to a fast-expanding project which provides mothers with prenatal care, HIV testing, treatment, pre-birth accommodation and nutritional support.
Kria is Media Relations Specialist for PIH www.pih.org